摘要
目的 探讨Ⅳ期肾上腺皮质癌临床及病理特点、治疗方案选择与预后分析。方法 回顾性分析Ⅳ期肾上腺皮质癌患者的临床资料,根据其临床表现、肾上腺内分泌功能、影像学特点和病理结果做出诊断,进行手术及米托坦药物联合治疗并随访。结果 纳入的76例肾上腺皮质癌患者中,肿瘤最大径6~16 cm,伴肾上腺中央静脉、肾静脉及下腔静脉瘤栓者6例。行根治性切除术57例,肾上腺巨大肿瘤并下腔静脉癌栓切除5例,腔静脉部分切除3例。术后复发时间为7.0~33.6个月。远处转移15例,肺转移18例,肝转移29例,合并腹膜后淋巴结转移23例,腰椎转移7例,卵巢转移3例,腹壁及切口种植5例,其他部位转移4例。复发转移者口服米托坦+氢化可的松治疗。随访8~60个月,手术5年以上的患者中有43例存活。结论 Ⅳ期肾上腺皮质癌早期诊断是关键,手术是有效的治疗方法,米托坦药物治疗可作为复发转移或无法手术治疗患者的辅助治疗。
Objective To investigate the clinical, functional imaging and pathological features of stage Ⅳ adrenocortical carcinoma(ACC), in order to improve the diagnosis and treatment of stage Ⅳ ACC. Methods Clinical manifestations, adrenal endocrine function detection, imaging examination characteristics and histopathological results determine the diagnosis, surgical treatment and follow-up of Mitotane medicine therapy.Results The maximum diameter of the tumor was 6~16 cm, with six cases of adrenal central vein, renal vein and inferior vena cava tumor thrombus. The recurrence time was 7.0~33.6 months after operation. Metastasis and recurrence in fifteen cases during follow-up, lung metastasis in eighteen cases, liver metastasis in twenty nine cases, retroperitoneal lymph node metastasis in twenty-three cases, lumbar metastasis in seven cases,ovarian metastasis in three cases, abdominal wall and incision implantation in five cases. Fifteen cases were with distant metastasis. Twelve patients were treated with renal and adrenal resection in the same side of the kidney. There were five cases of adrenal tumor with vena cava tumor thrombus in the removal of the tumor,and the other for the removal of the vena cava in four cases. Patients were followed up for 8~60 months, and forty-three patients survived for more than 5 years. Conclusion Function imaging combined with clinical features and endocrine hormone levels have important roles in stage Ⅳ ACC early diagnosis. Radical surgery is the only effective treatment. Adjuvant drug therapy can be used in surgical treatment to prevent recurrence and metastasis in ACC patients.
作者
邓建华
张学斌
张玉石
李汉忠
纪志刚
Deng Jian-hua;Zhang Xue-bin;Zhang Yu-shi;Li Han-zhong;Ji Zhi-gang(Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《兰州大学学报（医学版）》
2022年第6期31-34,共4页
Journal of Lanzhou University（Medical Sciences）
关键词
肾上腺皮质癌
核素成像
病理
米托坦
预后
adrenocortical carcinoma
nuclear imaging
pathology
Mitotane
prognosis
