{"title":"非转移性肾上腺皮质癌患者预后因素分析。","authors":"Haruyuki Ohsugi, Nae Takizawa, Takahiro Nakamoto, Takao Mishima, Katsunori Uchida, Hidefumi Kinoshita","doi":"10.5812/ijem-159772","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Adrenocortical carcinoma (ACC) is a very rare and aggressive disease with limited systemic therapeutic options.</p><p><strong>Objectives: </strong>Treatment with adjuvant mitotane is common after resection of ACC; however, high-risk patients often experience early recurrence. The risk factors for recurrence after surgery were analyzed in patients with non-metastatic ACC.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 20 patients who were treated for ACC between 1994 and 2023 at Kansai Medical University Hospital or Kansai Medical University Medical Center in Osaka, Japan. We studied the recurrence-free survival (RFS) rates of a subset of 15 patients with non-metastatic ACC [European network for the study of adrenal tumors (ENSATs) stage I-III]. Statistical analyses included the Kaplan-Meier survival analysis and the Cox proportional hazard model.</p><p><strong>Results: </strong>Of the 15 patients with non-metastatic ACC, nine patients (60%) experienced recurrence. The median RFS was seven months, and all recurrences occurred within 24 months. In all cases, the site of recurrence was the lungs or liver. Univariate analysis showed that ENSAT stage III classification [hazard ratio (HR) 6.974, P = 0.007] was the only factor that made a statistically significant difference to RFS. Although five of the six ENSAT stage III patients took adjuvant mitotane, all experienced recurrence.</p><p><strong>Conclusions: </strong>In patients with non-metastatic ACC, a diagnosis of ENSAT stage III is the only factor that significantly affects RFS. In these patients, adjuvant mitotane is likely insufficient to prevent recurrence.</p>","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"23 2","pages":"e159772"},"PeriodicalIF":1.8000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296635/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic Factors Among Patients with Non-metastatic Adrenocortical Carcinoma.\",\"authors\":\"Haruyuki Ohsugi, Nae Takizawa, Takahiro Nakamoto, Takao Mishima, Katsunori Uchida, Hidefumi Kinoshita\",\"doi\":\"10.5812/ijem-159772\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Adrenocortical carcinoma (ACC) is a very rare and aggressive disease with limited systemic therapeutic options.</p><p><strong>Objectives: </strong>Treatment with adjuvant mitotane is common after resection of ACC; however, high-risk patients often experience early recurrence. The risk factors for recurrence after surgery were analyzed in patients with non-metastatic ACC.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 20 patients who were treated for ACC between 1994 and 2023 at Kansai Medical University Hospital or Kansai Medical University Medical Center in Osaka, Japan. We studied the recurrence-free survival (RFS) rates of a subset of 15 patients with non-metastatic ACC [European network for the study of adrenal tumors (ENSATs) stage I-III]. Statistical analyses included the Kaplan-Meier survival analysis and the Cox proportional hazard model.</p><p><strong>Results: </strong>Of the 15 patients with non-metastatic ACC, nine patients (60%) experienced recurrence. The median RFS was seven months, and all recurrences occurred within 24 months. In all cases, the site of recurrence was the lungs or liver. Univariate analysis showed that ENSAT stage III classification [hazard ratio (HR) 6.974, P = 0.007] was the only factor that made a statistically significant difference to RFS. Although five of the six ENSAT stage III patients took adjuvant mitotane, all experienced recurrence.</p><p><strong>Conclusions: </strong>In patients with non-metastatic ACC, a diagnosis of ENSAT stage III is the only factor that significantly affects RFS. 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引用次数: 0
摘要
背景:肾上腺皮质癌(ACC)是一种非常罕见的侵袭性疾病,全身治疗选择有限。目的:辅助米托坦治疗ACC术后常见;然而,高危患者往往经历早期复发。分析非转移性ACC患者术后复发的危险因素。方法:回顾性分析1994年至2023年在日本大阪关西医科大学医院或关西医科大学医疗中心治疗的20例ACC患者的病历。我们研究了15例非转移性ACC患者的无复发生存率(RFS)[欧洲肾上腺肿瘤研究网络(ENSATs) I-III期]。统计分析包括Kaplan-Meier生存分析和Cox比例风险模型。结果:在15例非转移性ACC患者中,9例(60%)复发。中位RFS为7个月,所有复发发生在24个月内。所有病例的复发部位均为肺或肝。单因素分析显示,ENSAT III期分类[风险比(HR) 6.974, P = 0.007]是唯一与RFS有统计学差异的因素。尽管6名ENSAT III期患者中有5名服用了米托坦辅助治疗,但所有患者都出现了复发。结论:在非转移性ACC患者中,ENSAT III期诊断是唯一显著影响RFS的因素。在这些患者中,辅助使用米托坦可能不足以预防复发。
Prognostic Factors Among Patients with Non-metastatic Adrenocortical Carcinoma.
Background: Adrenocortical carcinoma (ACC) is a very rare and aggressive disease with limited systemic therapeutic options.
Objectives: Treatment with adjuvant mitotane is common after resection of ACC; however, high-risk patients often experience early recurrence. The risk factors for recurrence after surgery were analyzed in patients with non-metastatic ACC.
Methods: We retrospectively reviewed the medical records of 20 patients who were treated for ACC between 1994 and 2023 at Kansai Medical University Hospital or Kansai Medical University Medical Center in Osaka, Japan. We studied the recurrence-free survival (RFS) rates of a subset of 15 patients with non-metastatic ACC [European network for the study of adrenal tumors (ENSATs) stage I-III]. Statistical analyses included the Kaplan-Meier survival analysis and the Cox proportional hazard model.
Results: Of the 15 patients with non-metastatic ACC, nine patients (60%) experienced recurrence. The median RFS was seven months, and all recurrences occurred within 24 months. In all cases, the site of recurrence was the lungs or liver. Univariate analysis showed that ENSAT stage III classification [hazard ratio (HR) 6.974, P = 0.007] was the only factor that made a statistically significant difference to RFS. Although five of the six ENSAT stage III patients took adjuvant mitotane, all experienced recurrence.
Conclusions: In patients with non-metastatic ACC, a diagnosis of ENSAT stage III is the only factor that significantly affects RFS. In these patients, adjuvant mitotane is likely insufficient to prevent recurrence.
期刊介绍:
The aim of the International Journal of Endocrinology and Metabolism (IJEM) is to increase knowledge, stimulate research in the field of endocrinology, and promote better management of patients with endocrinological disorders. To achieve this goal, the journal publishes original research papers on human, animal and cell culture studies relevant to endocrinology.