肾上腺皮质癌临床病理特征及影响切除术后复发再手术患者的预后因素分析

doi:10.3969/j.issn.1671-7171.2023.04.016

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摘要【目的】探讨肾上腺皮质癌(ACC)临床病理特征及影响切除术后复发再手术患者的预后因素。【方法】61例ACC切除术后复发再手术的患者,术后随访2年。记录ACC患者的病理特征,分析影响ACC切除术后复发再手术患者预后的影响因素,利用Kaplan-Meier生存曲线统计生存情况。【结果】显微镜下患者癌组织多呈巢状、片状、条索状排列。2例为黏液样ACC,26例有高级别核,25例发现病理性核分裂象,30例核分裂象＞5个,43例呈弥漫性结构,39例透明细胞比例＜25%,41例有血管侵犯,43例有包膜侵犯。Cox回归分析显示,病理分级、ENSAT分期、乳酸脱氢酶(LDH)水平是影响ACC术后复发再手术患者术后总生存率的独立因素(P<0.05)。截至随访结束,失访6例。21例低分化ACC术后复发再手术患者存活5例,34例中高分化ACC术后复发再手术患者存活20例,中高分化ACC术后复发再手术患者的总存活曲线优于低分化患者(P<0.05)。23例Ⅲ期ACC术后复发再手术患者存活15例,32例Ⅳ期ACC术后复发再手术患者存活10例,Ⅲ期ACC术后复发再手术患者的总存活曲线优于Ⅳ期患者(P<0.05)。26例高LDH的ACC术后复发再手术患者存活8例,29例低LDH患者存活17例,低LDH的ACC术后复发再手术患者的总存活曲线优于高LDH患者(P<0.05)。【结论】ACC切除术后复发再手术患者预后差,免疫表型有助于病理诊断,分化程度低、分期晚、高LDH患者预后不良风险较高。

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	王彦军
	吴立峰

关键词 ：肾上腺皮质肿瘤/外科学, 肾上腺皮质肿瘤/病理学, 复发, 预后

Abstract：【Objective】 To explore the clinicopathological characteristics of adrenocortical carcinoma (ACC) and factors affecting the prognosis of patients with recurrence after resection and reoperation. 【Methods】 A total of 61 patients who had recurrence after ACC resection and reoperation were followed up for 2 years. The pathological characteristics of ACC were recorded,the factors affecting the prognosis of patients with recurrence after ACC resection and reoperation were analyzed,and the Kaplan-Meier survival curve was used to calculate the survival status. 【Results】 Under the microscope,the cancer tissues were mostly arranged in nests,flakes,and strips. Pathological diagnosis showed that 2 cases had mucinous ACC,26 cases had high-grade nuclei,25 cases had pathological mitotic figures,30 cases had mitotic figures> 5,43 cases showed diffuse structure,39 cases had clear cells <25%,41 cases had vascular invasion,and 43 cases had envelope violation. Cox regression analysis showed pathological grade,ENSAT stage,lactate dehydrogenase(LDH) were independent factors affecting the overall survival rate of patients with recurrence and reoperation after ACC (P<0.05). By the end of follow-up,6 cases were lost to follow-up. Five of the 21 patients with poorly differentiated ACC who underwent recurrence and reoperation survived,20 of the 34 patients with moderately and well differentiated ACC who had recurrence and reoperation survived. The overall survival curve of patients with moderately and well differentiated ACC with recurrence and reoperation after operation was better than that of poorly differentiated patients (P<0.05). Of the 23 patients with stage Ⅲ ACC recurrence and reoperation,15 survived.Among the 32 cases patients with stage Ⅳ ACC recurrence and reoperation,10 cases survived.The overall survival curve of patients with stage Ⅲ ACC recurrence and reoperation was better than that of stage Ⅳ patients (P<0.05). Of the 26 patients with high LDH ACC recurrence and reoperation,8survived. Among the 29 patients with low LDH ACC recurrence reoperation after surgery,17 survived. The overall survival curve of patients with low LDH and recurrence after ACC reoperation was better than that of patients with high LDH (P<0.05). 【Conclusion】 The prognosis of patients with recurrence after ACC resection and reoperation is poor. The immunophenotype is helpful for pathological diagnosis. Patients with low degree of tumor differentiation,late stage,and high LDH have a high risk of poor prognosis.

Key words： Adrenal Cortex Neoplasms/SU Adrenal Cortex Neoplasms/PA Recurrence Prognosis

收稿日期: 2022-06-20

中图分类号:

R736.6

通讯作者: * E-mail:46432668@qq.com

引用本文:

王彦军, 吴立峰. 肾上腺皮质癌临床病理特征及影响切除术后复发再手术患者的预后因素分析[J]. 医学临床研究, 2023, 40(4): 539-542.
WANG Yan-jun, WU Li-feng. Analysis of Clinicopathological Characteristics of Adrenocortical Carcinoma and Prognostic Factors in Patients with Recurrence after Resection and Reoperation. JOURNAL OF CLINICAL RESEARCH, 2023, 40(4): 539-542.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.04.016 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I4/539

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