肾上腺皮质癌诊断中的血清类固醇分析:一项前瞻性队列研究。

IF 5 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Kai Yu, Shobana Athimulam, Jasmine Saini, Ravinder Jeet Kaur, Qingping Xue, Travis J McKenzie, Ravinder J Singh, Stefan Grebe, Irina Bancos
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引用次数: 0

摘要

背景:指南建议对肾上腺肿瘤不确定患者进行尿液类固醇分析,以对肾上腺皮质癌(ACC)做出无创诊断。然而,尿液类固醇分析并不普及:目的:确定临床可用的血清 11-脱氧皮质醇、17OH-孕酮和 17OH-孕烯醇酮诊断 ACC 的准确性:我们对 2015-2023 年间接受评估的肾上腺肿块患者进行了一项前瞻性单中心队列研究。通过液相色谱-质谱法分析血清中的17OH-孕烯醇酮、17OH-孕酮、11-脱氧皮质醇。肾上腺肿块的参考标准包括组织病理学、影像学特征、影像学随访 2 年或临床随访 5 年。采用局部广义矩阵学习矢量量化(LGMLVQ)分析法制定血清类固醇评分,并以接收者操作曲线下面积(AUROC)进行评估:在263名肾上腺肿块患者中,44人(16.7%)被诊断为ACC,161人(61%)被诊断为肾上腺皮质腺瘤(ACA),27人(10%)被诊断为其他肾上腺恶性肿瘤,31人(12%)被诊断为其他。所有 ACC、除一种其他肾上腺恶性肿瘤外的所有其他肾上腺恶性肿瘤以及 58 例(31%)ACA 均显示 Hounsfield 单位(HU)≥ 20。ACC患者与非ACC患者相比,包括将ACC与功能正常的ACA相比,以及与HU≥20的ACA相比,所有3种类固醇都较高(PConclusions:我们的研究表明,11-脱氧皮质醇、17OH-孕酮和17OH-孕烯醇酮的测量值可用于诊断ACC。经过适当验证后,血清类固醇评分可纳入临床实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Serum steroid profiling in the diagnosis of adrenocortical carcinoma: a prospective cohort study.

Context: Guidelines suggest performing urine steroid profiling in patients with indeterminate adrenal tumors to make a noninvasive diagnosis of adrenocortical carcinoma (ACC). However, urine steroid profiling is not widely available.

Objective: To determine the accuracy of clinically available serum 11-deoxycortisol, 17OH-progesterone, and 17OH-pregnenolone in diagnosing ACC.

Methods: We conducted a prospective single-center cohort study of patients with adrenal masses evaluated between 2015-2023. Serum was analyzed by liquid chromatography-mass spectrometry for 17OH-pregnenolone, 17OH-progesterone, 11-deoxycortisol. Reference standard for adrenal mass included histopathology, imaging characteristics, imaging follow up of 2 years, or clinical follow up of 5 years. Localized Generalized Matrix Learning Vector Quantization (LGMLVQ) analysis was used to develop serum steroid score and assessed with area under receiver operating curve (AUROC).

Results: Of 263 patients with adrenal masses, 44 (16.7%) were diagnosed with ACC, 161 (61%) with adrenocortical adenomas (ACAs), 27 (10%) with other adrenal malignancies, and 31 (12%) with other. Hounsfield unit (HU) ≥ 20 was demonstrated in all ACCs, in all but one other adrenal malignancy, and in 58 (31%) ACAs. All 3 steroids were higher in patients with ACCs vs non-ACCs, including when comparing ACCs with functioning ACAs, and with ACAs with HU ≥ 20 (P<0.0001 for all). LGMLVQ analysis yielded a serum steroid score that discriminated between ACC and non-ACC groups with a mean threshold fixed AUROC of 0.823.

Conclusions: We showed that measurements of 11-deoxycortisol, 17OH-progesterone, and 17OH-pregnenolone could be valuable in diagnosing ACC. After appropriate validation, serum steroid score could be integrated in clinical practice.

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来源期刊
Journal of Clinical Endocrinology & Metabolism
Journal of Clinical Endocrinology & Metabolism 医学-内分泌学与代谢
CiteScore
11.40
自引率
5.20%
发文量
673
审稿时长
1 months
期刊介绍: The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.
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