Abstract：
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare yet highly malignant tumor associated with significant morbidity and mortality. This study aims to delineate the clinical features, survival patterns, and treatment modalities of ACC, providing insights into the disease\'s prognosis.
METHODS: A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital\'s database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses.
RESULTS: The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses.
CONCLUSIONS: ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.
METHODS: A retrospective analysis of 157 ACC patients was performed to assess treatment methodologies, demographic patterns, pathological and clinical attributes, and laboratory results. The data were extracted from the hospital\'s database. Survival analyses were conducted using the Kaplan-Meier method, with univariate and multivariate analyses being performed through the log-rank test and Cox regression analyses.
RESULTS: The median age was 45, and 89.4% had symptoms at the time of diagnosis. The median tumor size was 12 cm. A total of 117 (79.6%) patients underwent surgery. A positive surgical border was detected in 26 (24.1%) patients. Adjuvant therapy was administered to 44.4% of patients. The median overall survival for the entire cohort was 44.3 months. Median OS was found to be 87.3 months (95% confidence interval [CI] 74.4-100.2) in stage 2, 25.8 (95% CI 6.5-45.1) months in stage 3, and 13.3 (95% CI 7.0-19.6) months in stage 4 disease. Cox regression analysis identified age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as significant factors associated with survival in patients with nonmetastatic disease. In metastatic disease, only patients who underwent surgery exhibited significantly improved overall survival in univariate analyses.
CONCLUSIONS: ACC is an uncommon tumor with a generally poor prognosis. Understanding the defining prognostic factors in both localized and metastatic diseases is vital. This study underscores age, Ki67 value, Eastern Cooperative Oncology Group performance status, and hormonal activity as key prognostic determinants for localized disease, offering critical insights into the complexities of ACC management and potential avenues for targeted therapeutic interventions.
摘要：
背景：肾上腺皮质癌（ACC）是一种罕见但高度恶性的肿瘤，具有显著的发病率和死亡率。本研究旨在描述临床特征，生存模式,和ACC的治疗方式，提供对疾病预后的见解。
方法：对157例ACC患者进行回顾性分析，以评估治疗方法，人口模式，病理和临床属性，和实验室结果。数据是从医院的数据库中提取的。使用Kaplan-Meier方法进行生存分析，通过对数秩检验和Cox回归分析进行单变量和多变量分析。
结果：中位年龄为45岁，89.4％的患者在诊断时出现症状。中位肿瘤大小为12cm。共有117例（79.6％）患者接受了手术。在26例（24.1％）患者中检测到阳性手术边界。44.4%的患者接受了辅助治疗。整个队列的中位总生存期为44.3个月。在第2阶段，中位OS为87.3个月（95％置信区间[CI]74.4-100.2），在第3阶段为25.8（95％CI6.5-45.1）个月，在第4阶段为13.3（95％CI7.0-19.6）个月。Cox回归分析确定年龄，Ki67值，东部肿瘤协作组的表现状况，和激素活性是与非转移性疾病患者生存相关的重要因素。在转移性疾病中，在单因素分析中,只有接受手术的患者的总生存期显著提高.
结论：ACC是一种罕见的肿瘤，通常预后较差。了解局部和转移性疾病的定义预后因素至关重要。这项研究强调了年龄，Ki67值，东部肿瘤协作组的表现状况，和激素活动作为局部疾病的关键预后决定因素，提供对ACC管理的复杂性和有针对性的治疗干预的潜在途径的关键见解。
方法：对157例ACC患者进行回顾性分析，以评估治疗方法，人口模式，病理和临床属性，和实验室结果。数据是从医院的数据库中提取的。使用Kaplan-Meier方法进行生存分析，通过对数秩检验和Cox回归分析进行单变量和多变量分析。
结果：中位年龄为45岁，89.4％的患者在诊断时出现症状。中位肿瘤大小为12cm。共有117例（79.6％）患者接受了手术。在26例（24.1％）患者中检测到阳性手术边界。44.4%的患者接受了辅助治疗。整个队列的中位总生存期为44.3个月。在第2阶段，中位OS为87.3个月（95％置信区间[CI]74.4-100.2），在第3阶段为25.8（95％CI6.5-45.1）个月，在第4阶段为13.3（95％CI7.0-19.6）个月。Cox回归分析确定年龄，Ki67值，东部肿瘤协作组的表现状况，和激素活性是与非转移性疾病患者生存相关的重要因素。在转移性疾病中，在单因素分析中,只有接受手术的患者的总生存期显著提高.
结论：ACC是一种罕见的肿瘤，通常预后较差。了解局部和转移性疾病的定义预后因素至关重要。这项研究强调了年龄，Ki67值，东部肿瘤协作组的表现状况，和激素活动作为局部疾病的关键预后决定因素，提供对ACC管理的复杂性和有针对性的治疗干预的潜在途径的关键见解。
