单中心肾上腺转移瘤210例临床诊疗分析

Clinical characteristics,diagnosis and treatment analysis of 210 cases adrenal metastases in single center

目的分析肾上腺转移瘤的临床特点,总结诊治经验,分析预后。方法回顾性分析北京协和医院1990年1月至2021年6月收治的210例肾上腺转移瘤患者的临床资料及复习相关文献,总结手术与非手术治疗的肾上腺转移瘤患者的临床特点、原发肿瘤类型、诊疗方案和预后。结果210例患者中,男153例,女57例,年龄为(60±12)岁。瘤体最大径为(4.7±2.6)cm,范围为0.5~14.5 cm;发生于左侧84例,右侧81例,双侧44例。210例患者的原发肿瘤依次为肺癌72例,肾癌48例,肝胆管癌29例,结直肠癌18例,胃食管癌11例,胰腺癌6例,乳腺癌5例,黑色素瘤3例,其他18例。108例患者无明显不适临床症状,仅为原发肿瘤复查或常规体检时发现,102例为原发疾病相关不适症状。210例患者均无满月脸、水牛背等内分泌异常体征。原发肿瘤确诊至发现肾上腺转移的中位时间为3个月,95例为与原发肿瘤同时发现,最长时间为228个月。210例患者中,术前检查203例行CT,99例PET-CT,74例B超,25例MRI。122例患者通过病史与影像学检查临床诊断为肾上腺转移瘤,1例行肾上腺光子刀治疗,1例行肾上腺动脉栓塞化疗,21例行肾上腺放疗或CT引导下肾上腺射频消融术,其余为针对原发癌的全身放化疗及靶向药物治疗。88例患者通过组织病理学确诊为肾上腺转移瘤,其中12例患者通过CT引导下肾上腺穿刺确诊,74例患者通过肾上腺手术确诊,2例患者经穿刺确诊为肾上腺转移瘤后进一步行转移瘤切除术,最终均经病理确诊为恶性肿瘤肾上腺转移,继续予以原发肿瘤治疗。210例患者的总生存期为(25±28)个月,其中134例未手术的患者总生存期为(23±30)个月,76例手术治疗的患者总生存期为(28±24)个月。结论肾上腺转移瘤原发肿瘤类型在我院未手术患者以肺癌居多,而手术患者则为肾癌最多,老年男性居多,均无明显的内分泌相关特征性症状及体征。CT为有效的检查手段,辅以B超或PET诊断准确率将进一步提高,但确诊仍依赖于组织病理学检查。孤立性肾上腺转移瘤的患者,手术治疗可明显改善预后,但也需根据患者的一般状况,原发肿瘤类型、生物学行为及转移瘤的特点进行综合治疗,才能取得最佳疗效。

Objective To analyze the clinical features of adrenal metastases and summarize the experience of diagnosis and treatment.Methods The clinicopathological data of 210 patients with adrenal metastases admitted to Peking Union Medical College Hospital from Jan.1990 to Jun.2021 were retrospectively analyzed,and the relevant literature was reviewed.The clinical characteristics,primary tumor types,imaging examination methods and diagnosis and treatment methods of adrenal metastases were summarized.Results Among 210 patients,153 were males and 57 were females,with an average age of(60±12)years.The average maximum diameter of the tumor was(4.7±2.6)cm,the maximum was 14.5 cm,and the minimum was 0.5 cm.Tumor occurred in 84 cases on the left,81 cases on the right,and 44 cases bilateral.The primary tumors of 210 patients were 72 cases of lung cancer,48 cases of renal cancer,29 cases of hepatobiliary cancer,18 cases of colorectal cancer,11 cases of gastric esophageal cancer,6 cases of pancreatic cancer,5 cases of breast cancer,3 cases of melanoma,and 18 cases of other tumors.108 patients had no obvious clinical symptoms of discomfort,only found in the review of primary tumor or routine physical examination.102 were primary disease-related symptoms,and 210 patients had no abnormal endocrine signs such as moon face and buffalo back.The median time from diagnosis of primary tumor to adrenal metastasis was 3 months.95 cases were diagnosed with primary tumor at the same time.The longest time was 228 months.Of the 210 patients,203 underwent CT,99 PET-CT,74 B-ultrasound and 25 MRI.A total of 122 patients were clinically diagnosed as adrenal metastasis by history and imaging examination.One patient was treated with adrenal photon knife,one patient was treated with adrenal artery embolization chemotherapy,and 21 patients were treated with adrenal radiotherapy or CT-guided adrenal radiofrequency ablation.A total of 88 patients were diagnosed as adrenal metastasis by histopathology.Among them,12 patients were diagnosed by adrenal puncture under CT guidance,74 patients were diagnosed by adrenal surgery,and 2 patients were further treated with metastatic tumor resection after adrenal metastasis was diagnosed by puncture.Finally,all patients were diagnosed as adrenal metastasis of malignant tumor by pathology,and they continued to be treated with primary tumor.Conclusions Lung cancer is the most common type of primary adrenal metastases in our hospital.Most of the elderly men have no obvious endocrine-related symptoms and signs.CT is an effective means of examination,supplemented by B ultrasound or MRI diagnostic accuracy will be further improved,but the diagnosis still depends on histopathological examination.For patients with isolated adrenal metastasis,surgical treatment can significantly improve the prognosis.However,comprehensive treatment should be carried out according to the general situation of patients,the type and biological behavior of primary tumors,and the characteristics of metastatic tumors,so as to achieve the best curative effect.