20例肾上腺皮质癌的手术治疗及预后分析

Surgical treatment and prognosis of 20 cases of adrenocortical carcinoma

目的探讨肾上腺皮质癌(ACC)的临床特征、手术治疗及预后因素,提高其诊治水平。方法回顾性分析2015年9月至2020年7月我院收治的20例ACC患者的临床资料,采用Kaplan-Meier法绘制生存曲线,分析各因素与患者无疾病进展生存期(PFS)和总生存期(OS)的关系。运用Cox回归模型进行多因素分析,预测ACC预后影响因素。结果20例ACC患者均成功施行手术治疗,平均随访时间(28.5±19.7)个月。存活13例,中位生存时间37.0个月;死亡7例,中位生存时间7.0个月。单因素分析提示肿瘤分期、血钾、Ki-67值是患者PFS及OS的影响因素(P<0.05)。Ki-67对应PFS及OS的预后最佳截断值分别为30%和40%。多因素Cox回归分析提示,肿瘤分期晚(HR=5.973,P=0.039)、低钾血症(HR=18.183,P=0.007)、高Ki-67(>30%)值(HR=10.889,P=0.027)的患者无疾病进展时间短;低钾血症(HR=19.826,P=0.011)、高Ki-67(>40%)值(HR=25.721,P=0.006)的患者死亡风险增加。结论ACC就诊时多处于中晚期,预后差。肿瘤分期、Ki-67值、血钾是ACC术后疾病进展的影响因素,肿瘤分期晚、高Ki-67值、低钾血症的患者疾病进展快。Ki-67值、血钾是ACC术后独立预后因素,高Ki-67值、低钾血症的患者提示预后不良。

Objective To investigate the clinical features,surgical treatment and prognostic factors of adrenocortical carcinoma(ACC),and to improve the level of diagnosis and treatment.Methods The clinical data of 20 patients with ACC in our hospital from September 2015 to July 2020 were analyzed retrospectively.The survival curve was drawn by Kaplan Meier method,and the relationship between various factors and progression free survival(PFS)and overall survival(OS)were analyzed.Multivariate analysis was carried out by Cox regression model,and prognostic factors of ACC were predicted.Results All 20 patients with ACC were successfully treated with surgery.The average follow-up time was(28.5±19.7)months.Thirteen patients survived and the median survival time was 37.0 months.Seven patients died and the median survival time was 7.0 months.Univariate analysis showed that tumor stage,blood potassium and Ki-67 were the influence factors of PFS and OS(P<0.05).The optimal cut-off values of Ki-67 for PFS and OS were 30%and 40%respectively.Cox multivariate analysis showed that advanced tumor stage(HR=5.973,P=0.039),hypokalemia(HR=18.183,P=0.007),high Ki-67(>30%)value(HR=10.889,P=0.027)were associated with short PFS.Hypokalemia(HR=19.826,P=0.011)and high Ki-67(>40%)value(HR=25.721,P=0.006)increased the risk of death.Conclusions ACC was mostly in the middle and advanced stage,so the prognosis was poor.Tumor stage,Ki-67 value and blood potassium were the influence factors of disease progression after operation.Patients with advanced tumor stage,high Ki-67 value and hypokalemia had rapid disease progression.Ki-67 value and blood potassium were independent prognostic factors after operation,so patients with high Ki-67 value and hypokalemia predicted poor prognosis.