成人肾上腺皮质癌预后因素的分析

目的 探讨成人肾上腺皮质癌(ACC）的潜在预后因素。方法 回顾性纳入2000年1月1日至2013年1月31日在四川大学华西医院就诊并经术后病理确诊为ACC的成年(≥18岁)患者，收集患者临床资料及术前实验室检查结果。生存率的计算采用Kaplan-Meier法，各组间生存率的比较采用Log-rank时序检验，多因素分析采用Cox比例风险回归模型。结果 纳入成人ACC共52例。中位随访时间26月(3～159月)，中位生存期29月(1～156月)，1年、3年及5年生存率分别为71.0%、47.0%及42.7%。单因素分析提示年龄＞45岁(\P=0.017)、分期晚(Ⅲ~Ⅳ期,\P\P=0.011)、具有临床症状(\P=0.017)、合并低蛋白血症(\P=0.003)及血清乳酸脱氢酶（LDH）升高(\P=0.004)的患者预后差。多因素分析提示低蛋白血症(死亡风险比5.306，95%可信区间:1.975~14.258, \P=0.001)、女性(死亡风险比4.020，95%可信区间:1.610~10.038, \P=0.003)、肿瘤分期晚(死亡风险比7.405，95%可信区间:2.561~21.410, \P\P=0.002）的患者死亡风险增加。结论 术前低蛋白血症、女性性别、年龄＞45岁及肿瘤分期晚是成人ACC预后的独立危险因素。

Prognostic Determinants of Adrenocortical Carcinoma in Adults

Objective To investigate the clinical features and prognostic determinants of adrenocortical carcinoma (ACC) in adult patients. Methods All adult patients (aged≥18 years old) who were admitted to West China Hospital, Sichuan University from 1st Jan., 2000 to 31st Jan., 2013 with a pathologically diagnosed ACC were included in this study. Data about the demographics, clinical characteristics, laboratory examinations and outcomes of those patients were extracted and analyzed. Results A total of 52 cases were identified, with a median follow-up of 26 months (3-159 months). The patients had a median survival time of 29 months (1-156 months), with a 1-year, 3-year, and 5-year survival rate of 71.0%, 47.0%, and 42.7%, respectively. In the univariate analysis, aged >45 years old at diagnosis (\P=0.017), advanced stage (Ⅲ-Ⅳ stage, \P\P=0.011), symptomatic (\P=0.017), hypoalbuminemia (\P=0.003), and elevated lactate dehydrogenase (LDH) (\P=0.017) were associated with poor prognosis of ACC. The multivariate analysis confirmed that hypoalbuminemia 〔hazard ratio (\HR)=5.306; 95% confidence interval (95%\CI: 1.975, 14.258; \P=0.001〕, female (\HR=4.020; 95%\CI: 1.610, 10.038; \P=0.003), advanced stage (\HR=7.405; 95%\CI: 2.561, 21.410; \P\HR=4.628; 95%\CI: 1.791, 11.959; \P=0.002) were predictors of poor prognosis of ACC. Conclusion Hypoalbuminemia, female, older age, and advanced stage are independent risk factors associated with poor prognosis of ACC in adult patients.