基于SEER数据库回顾性分析肾上腺皮质癌的放疗价值

Retrospective analysis of value of radiotherapy for adrenocortical carcinoma based on the SEER database

目的研究辅助放疗对肾上腺皮质癌(adrenocortical carcinoma,ACC)患者的生存率以及相关预后因素的影响。方法本研究从SEER数据库(2004—2017)中筛选符合标准的ACC患者数据,并通过Kaplan-Meier曲线和log-rank分析比较术后放疗与单纯手术两组的生存差异,包括总生存时间(overall survival,OS)和肿瘤特异性生存时间(cancer-specific survival,CSS)。通过Cox回归模型分析影响预后的因素,并将具有1个及以下危险因素的患者分类为低危组,2个及以上危险因素的患者分为高危组,得出两组的OS及CSS,并分析在两个亚组中辅助放疗对患者OS的影响。结果本研究共纳入399名ACC患者,中位年龄57(1~85)岁。单因素分析显示年龄越小、组织学分级越低、分期越早、淋巴结清扫数目≤19枚、阳性淋巴结数<4枚、放疗均提示了较好的OS及CSS(P<0.05)。多因素分析说明了辅助放疗对提高术后患者OS优势明显(HR,0.62;95%CI,0.41~0.92;P=0.018),其中年龄>60岁、ENSATⅢ~Ⅳ期、组织学高级别和阳性淋巴结大于4枚以上患者OS及CSS较差(P<0.05)。此外,高危组的患者在辅助放疗后生存获益明显(5年OS率:87.1%对90.0%;P=0.048),而低危组ACC患者未发现生存获益(P=0.46)。结论接受手术联合放疗可能比单纯手术ACC患者的提高生存率和肿瘤特异生存率,尤其在具有2个及以上危险因素的高危组患者中。

Objectivee To assess the impact of adjuvant radiotherapy on the survival of patients who underwent surgery for adrenocortical carcinoma(ACC),as well as to analyze prognostic factors related to patient outcomes.Methods Data from the SEER database(2004-2017)of patients with ACC who met the criteria were included.Survival curves,overall survival(OS)and tumor-specific survival(CSS)were obtained by Kaplan-Meier curves and log-rank analysis for both postoperative radiotherapy and surgery alone groups,and Cox's equal proportional risk regression model was used to analyze the factors affecting The factors affecting prognosis were analyzed using Cox's risk regression model.Patients with one or less risk factors were classified as low-risk group,and patients with two or more risk factors were classified as high-risk group to derive OS and CSS in both groups,and to analyze the effect of adjuvant radiotherapy on patients'OS in both subgroups.Results A total of 399 ACC patients,with a median age of 57 years(ranging from 1 to 85),were included in the study.Univariate analysis revealed that younger age,lower histological grade,earlier staging,clearance of≤19 lymph nodes,fewer than 4 positive lymph nodes,and receiving radiotherapy were all associated with better overall survival(OS)and cancer-specific survival(CSS).(P<0.05).Multifactorial analysis showed that adjuvant radiotherapy significantly improved OS in postoperative patients(HR,0.62;95%CI,0.41-0.92;P=0.018),with poorer OS and CSS in patients aged>60 years,In patients with ENSAT stage II~IV,high histological grade,and more than 4 positive lymph nodes(P<0.05),significant associations were observed.Furthermore,among patients in the high-risk group(5-year OS rate:87.1%versus 90.0%;P=0.048),adjuvant radiotherapy showed a significant benefit.However,no survival benefit was found in patients with ACC in the low-risk group.Conclusion Receiving surgery combined with radiotherapy may improve survival and tumor-specific survival over patients with surgical ACC alone,especially in the high-risk group of patients with 2 or more risk factors.