Abstract

Background: Adrenocortical cancer (ACC) is a rare adrenal neoplasm with aggressive clinical course and poor prognosis, and with many unresolved problems of diagnostics, treatment and predictive factors. Aim: To identify the most significant clinical and morphological predictors of the outcome based on assessment of long-term results of surgical treatment of ACC patients. Materials and methods: This retrospective study included data on diagnosis and results of treatment of 73 ACC patients from 1999 to 2015. Results: Radical surgery was performed in 59 patients, and long-term results assessed in 52 of them (maximal duration of the follow-up was 12 years). The most favorable treatment results were seen in stages I and II of the disease, with a 5-year survival rate of 87%. The 5-year overall survival in patients with ACC stage III was significantly (p=0.042, multiple comparisons) lower (48%). Two patients who had been operated with ACC stage IV (adrenalectomy with excision of a solid liver metastasis and atypical lung resection) died of progressive tumor within 13 months after surgery. The survival rates in patients with stage III of the tumor were evaluated depending on the main clinical characteristics of the tumor. It was shown that the 5-year overall survival in non-functioning adrenocortical carcinomas was 59%, being significantly (p<0.05) better than that in patients with functionally active malignancies (22%). In the group of patients without metastases in the regional lymphatic nodes, the 5-year overall survival was 56%, whereas all patients with regional lymphatic metastases by the time of the surgery died from progression within 4 years after the intervention. There was an association between 5-year overall survival and the size of primary tumor, with significantly (p<0.05) lower numbers of 5-year overall survivors (29%) among those with tumors of more than 10 cm in diameter, compared with 65% survival rate in those with tumors of less than 10 cm. Conclusion: The results obtained confirm that the stage of ACC by the time of diagnosis is the major prognostic factor. Functional activity of the tumor, its size and regional lymphatic node metastases also have some prognostic value. At present, surgical intervention remains the single radical treatment approach to ACC; however, its results are far from being satisfactory. Patients with ACC stage III and IV require an individual approach to assessment of prognosis and to the choice of the treatment strategy after potentially curative surgery, which is possible based on immunohistochemical molecular biologic tests of the tumor.

Highlights

  • Adrenocortical cancer (ACC) is a rare adrenal neoplasm with aggressive clinical course and poor prognosis, and with many unresolved problems of diagnostics, treatment and predictive factors

  • Что 5-летняя общая выживаемость при гормонально-неактивных карциномах коры надпочечника составила 59% и была достоверно (p < 0,05) выше по сравнению с таковой (22%) у больных, имевших функционирующие новообразования

  • Установлено, что 5-летняя общая выживаемость при гормонально-неактивном Адренокортикальный рак (АКР) составила 59% и была достоверно (p < 0,05) выше по сравнению с соответствующим показателем (22%) у больных с функционирующими опухолями

Read more

Summary

Материал и методы

В отделении хирургической эндокринологии ГБУЗ МО МОНИКИ им. На обследовании и лечении находилось 73 больных АКР (28 мужчин, 45 женщин) в возрасте от 21 до 76 лет (средний возраст – 52 года). На основании клинических данных и результатов гормональных исследований у 19 больных верифицирован синдром Кушинга, у 1 вирильный синдром, у 1 вирильный синдром в сочетании с синдромом Кушинга, у 2 пациентов тотальный адреногиперкортицизм. Стадию заболевания определяли согласно классификации ENSAT [5, 6]. У большинства (46 из 73; 63%) пациентов установлена III стадия АКР. Первая стадия верифицирована у 3 (4%), II – у 11 (15%), IV – у 13 (18%). Для лучевой топической диагностики использовали ультразвуковое исследование (УЗИ), компьютерную томографию (КТ), в последние годы – мультиспиральную компьютерную томографию

Стадия адренокортикального рака
Оригинальные статьи
Обсуждение и заключение
Findings
Background
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call