肾上腺转移癌的临床特征和预后影响因素

Clinical features and prognostic analysis of adrenal metastasis tumor

目的探讨肾上腺转移癌的临床特征和预后影响因素。方法回顾性分析2015年5月至2022年8月广西医科大学第一附属医院收治的37例肾上腺转移癌患者的临床资料。男30例,女7例。中位年龄54(43,62)岁,其中≥60岁13例,<60岁24例。转移癌位于右侧22例,左侧12例,双侧3例。转移癌最大径<3cm10例,3~6cm18例,>6cm9例。同时转移(与原发肿瘤同时确诊肾上腺转移癌)20例,异时转移(原发肿瘤确诊后发现肾上腺转移癌)17例。单纯肾上腺转移癌20例,除肾上腺转移癌外还合并其他远处转移17例。行肾上腺转移癌切除术16例,肾上腺转移癌切除术联合其他脏器切除术15例,超声引导下肾上腺转移癌穿刺活检术6例。仅行手术治疗18例,行综合治疗(手术、化疗、放疗、免疫、靶向、介入和粒子植入)19例。肾上腺转移癌术后病理为肝细胞癌12例,肾透明细胞癌8例,肺腺癌5例,结肠腺癌和神经母细胞瘤各2例,肾盂癌、胃腺癌、胆管细胞癌、肾乳头状细胞癌、结肠腺鳞癌、胸腺小细胞癌、子宫内膜癌、弥漫型大B细胞淋巴瘤各1例。采用Kaplan-Meier法绘制生存曲线,采用log-rank检验分析患者的临床特征与总生存期(OS)和无进展生存期(PFS)的关系,采用Cox比例风险回归模型分析影响患者OS的因素。结果本研究37例,中位随访时间10(4.0,18.5)个月,6个月、1年、2年的总生存率分别为59.5%(22/37)、43.2%(16/37)、32.4%(12/37)。18例仅行手术治疗患者6个月、1年、2年的总生存率分别为66.7%(12/18)、44.4%(8/18)、27.8%(5/18);19例综合治疗患者6个月、1年、2年的总生存率分别为52.6%(10/19)42.1%(8/19)、36.8%(7/19),两组总生存率的差异无统计学意义(P=0.773)。Kaplan-Meier生存曲线显示转移癌侧别是OS(P=0.012)和PFS(P=0.013)的危险因素,转移癌发现时间是OS的危险因素(P=0.021)。单因素Cox回归分析结果显示,转移癌发现时间(HR=2.5,95%CI1.1~5.4,P=0.021)、转移癌侧别(HR=3.6,95%CI1.5~8.5,P=0.004)、肺源性转移癌(HR=3.6,95%CI1.1~11.0,P=0.032)、原发肿瘤病理为腺癌(HR=3.2,95%CI1.2~8.8,P=0.025)是影响OS的危险因素。多因素Cox回归分析结果显示,同时转移(HR=2.6,95%CI1.1~6.2,P=0.033)和转移癌位于左侧(HR=3.6,95%CI1.5~8.6,P=0.005)是影响0S的独立危险因素。结论本研究患者肾上腺转移癌最常见的病理类型为肝细胞癌,以手术为主的综合治疗可能使患者受益。肾上腺转移癌的发现时间、侧别、肿瘤来源和原发肿瘤病理类型是影响患者预后的危险因素。同时转移和转移癌位于左侧是肾上腺转移癌患者OS的独立危险因素。

Objective To discuss the clinical features and prognostic factors of adrenal metastases.Methods The clinical data of 37 patients with adrenal metastases admitted to the First Affiliated Hospital of Guangxi Medical University from May 2015 to August 2022 were retrospectively analyzed.There were 30 males and 7 females.The median age was 54(43,62)years old,including 13 cases aged≥60 years old and 24 cases aged<60 years old.There were 22 cases of right metastasis,12 cases of left metastasis and 3 cases of bilateral metastasis.The maximum diameter of metastatic carcinoma was<3 cm in 10 cases,3-6 cm in 18 cases,and>6 cm in 9 cases.There were 20 cases of synchronous metastasis(diagnosed with adrenal metastasis at the same time as the primary tumor)and 17 cases of metachronous metastasis(found after the diagnosis of primary tumor).There were 20 cases of adrenal metastasis alone and 17 cases of adrenal metastasis combined with other distant metastasis.16 cases underwent adrenalectomy,15 cases underwent adrenalectomy combined with other organ resection,and 6 cases underwent ultrasound-guided needle biopsy.18 patients were treated with surgery alone,and 19 patients were treated with combined treatment(surgery,chemotherapy,radiotherapy,immunotherapy,targeted therapy,interventional therapy and seed implantation)..There were 12 cases of hepatocellular carcinoma,8 cases of renal clear cell carcinoma,5 cases of lung adenocarcinoma,2 cases of colon adenocarcinoma,2 cases of neuroblastoma,1 case of renal pelvis carcinoma,1 case of gastric adenocarcinoma,1 case of cholangiocarcinoma,1 case of renal papillary cell carcinoma,1 case of colon adenosquamous carcinoma,1 case of thymic small cell carcinoma,1 case of endometrial carcinoma,and 1 case of diffuse large B-cell lymphoma.The Kaplan-Meier method was used to draw the survival curve,the log-rank test was used to analyze the relationship between the clinical characteristics of patients and overall survival(OS)and progression-free survival(PFS),and the Cox proportional hazards regression model was used to analyze the factors affecting OS.Results The median follow-up time of the 37 patients was 10(4,18.5)months.The overall survival rates at 6 months,1 year and 2 years were 59.5%(22/37),43.2%(16/37)and 32.4%(12/37),respectively.The 6-month,1-year and 2-year overall survival rates of 18 patients who underwent surgery alone were 66.7%(12/18),44.4%(8/18)and 27.8%(5/18),respectively.The 6 months,1 year and 2 years overall survival rates of 19 patients with comprehensive treatment were 52.6%(10/19),42.1%(8/19)and 36.8%(7/19),respectively.There was no significant dfference in overall survival rate between the two groups(P=0.773).Kaplan-Meier survival curve analysis showed that the side of metastatic cancer was a risk factor for OS(P=0.012)and PFS(P=0.013),and the time of diagnosis of metastatic cancer was a risk factor for OS(P=0.021).Univariate Cox regression analysis showed that,time to diagnosis of metastases(HR=2.5,95%CI 1.1-5.4,P=0.021),side of metastases(HR=3.6,95%CI 1.5-8.5,P=0.004),pulmonary metastases(HR=3.6,95%CI 1.1-11.0,P=0.032)and adenocarcinoma of the primary tumor(HR=3.2,95%CI 1.2-8.8,P=0.025)were risk factors for OS.Multivariate Cox regression analysis showed that simultaneous presence of metastases(HR=2.6,95%CI 1.1-6.2,P=0.033)and metastases located on the left side(HR=3.6,95%CI 1.5-8.6,P=0.005)were independent risk factors for 0S.Conclusions Hepatocellular carcinoma is the most common pathological type of adrenal metastases in this study.Patients may benefit from combined therapy based on surgery.The time of diagnosis,side,tumor origin and pathological type of primary tumor are the prognostic factors of adrenal metastases.Simultaneous presence of metastases and left-sided metastases are independent risk factors for OS in patients with adrenal metastases.