这项研究旨在描述2000-2021年间诊断为肾上腺皮质癌的大量匈牙利患者的临床病理特征和预后因素。
这项回顾性研究纳入了一个三级转诊内分泌中心的74例经组织学证实的肾上腺皮质癌患者(27名男性和47名女性)。进行了描述性统计,提供选定的临床和病理参数的摘要。分析了影响总生存率的临床病理因素。
诊断时患者的中位年龄为48,5岁(17-84岁)。大多数病例诊断为ENSATII期(39.2%)和IV期(33.8%)。诊断时,中位肿瘤大小为9,0cm(4,5-20cm)。在47名患者中(71,6%),肿瘤是荷尔蒙活跃的。中位总生存期和5年生存率分别为23,5个月(95%CI,17-30,5个月)和18,3%,分别。68例患者(91,8%)进行了原发性肿瘤切除术;30例患者实现了R0手术切除。在单变量Cox回归模型中,III期和IV期肿瘤,高增殖活性(Ki67指数>10%),R1-R2手术切除状态和激素活性与较差的生存率相关。皮质醇过量,既分离,又与雄激素生产相结合,与较差的生存率有关。55例患者接受米托坦治疗。与从未达到米托坦血药浓度的患者相比,达到治疗性米托坦血药浓度的患者的总生存期明显更好[27.0(2-175)个月vs18.0(2-83)个月;p<0.05]。年龄中位数,性别的分布,ENSAT阶段,两组的切除状态和Ki67指数无差异.达到血清米托坦治疗范围所需的时间为96.5天(95%CI,75-133天)。
我们的结果证实了以前的数据,即疾病阶段,有丝分裂活性,切除状态和达到治疗浓度的米托坦治疗是影响肾上腺皮质癌预后的最关键参数。我们的数据表明,荷尔蒙活动可能比以前描述的更频繁,是总生存期的一个强有力的独立预后因素。据我们所知,这是第一项单中心研究,证实达到治疗性米托坦浓度对预后的重要性.
This study aimed to characterise the clinicopathological features and prognostic factors of a large cohort of Hungarian patients with adrenocortical cancer diagnosed between 2000-2021.
This retrospective study included seventy-four patients (27 men and 47 women) with histologically confirmed adrenocortical cancer in a single tertiary referral endocrine centre. Descriptive statistics were performed, providing summaries of selected clinical and pathological parameters. Clinicopathological factors contributing to overall survival were analysed.
The median age of patients was 48,5 years (17-84 years) at diagnosis. The majority of cases were diagnosed at ENSAT stage II (39,2%) and stage IV (33,8%). At diagnosis, the median tumour size was 9,0 cm (4,5-20 cm). In 47 patients (71,6%), the tumour was hormonally active. The median overall survival and the 5-year survival rate were 23,5 months (95% CI, 17-30,5 months) and 18,3%, respectively. Primary tumour resection was performed in 68 patients (91,8%); R0 surgical resection was achieved in 30 patients. In univariate Cox regression model, tumours with stages III and IV, high proliferative activity (Ki67-index > 10%), R1-R2 surgical resection state and hormonal activity were associated with poorer survival. Cortisol excess, both isolated and combined with androgen production, was associated with poorer survival. Fifty-five patients were treated with mitotane. The overall survival of patients achieving therapeutic mitotane plasma concentration was significantly better compared to those who never reached it [27.0 (2-175) months vs 18.0 (2-83) months; p<0.05)]. The median age, the distribution of gender, ENSAT stage, resection state and Ki67-index did not differ between these two groups. The time needed to reach the therapeutic range of serum mitotane was 96.5 days (95% CI, 75-133 days).
Our results confirm previous data that disease stage, mitotic activity, the resection state and the mitotane treatment achieving therapeutic concentration are the most critical parameters influencing the prognosis of adrenocortical cancer. Our data suggest that hormonal activity may be more frequent than described previously, and it is a strong and independent prognostic factor of overall survival. To our knowledge, this is the first single-centre study confirming the prognostic importance of achieving therapeutic mitotane concentration.