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目的分析探讨肾上腺皮质癌(adrenocortical carcinomas,ACC)患者行根治性切除术后的长期生存率及相关影响因素,为临床判别患者死亡风险增高因素提供参考。方法回顾分析金华市人民医院2005年1月—2010年1月期间经病理活检确认为ACC并行根治性肾上腺切除术的18例ACC患者临床资料,应用Cox比例风险模型行单因素分析,采用Kaplan-Meier法计算患者生存率,采用log-rank法进行生存率的比较,分析患者长期预后及影响预后的因素。结果本组患者的中位年龄为48岁(23~67岁)。18例患者的中位随访时间是75个月(3~165个月),患者的3年、5年及10年生存率分别为55.5%、44.4%和16.7%。中位生存时间为46个月(1~158个月)。单因素分析显示肿瘤浸润程度及淋巴结转移与长期预后有关(P=0.02、0.01);此外,患者的3年、5年及10年无瘤生存率分别为55.5%、33.3%和33.3%。单因素分析显示,肿瘤浸润程度及淋巴结转移亦与无瘤生存周期有关(P<0.01、P=0.03)。结论根治性切除术可为ACC提供治愈的机会,肿瘤浸润程度及淋巴结转移是影响ACC患者预后的重要因素。
Objective To investigate the long-term survival rate and its related factors after radical resection in patients with adrenocortical carcinomas (ACC), and to provide reference for the clinical diagnosis of patients with increased risk of death. Methods The clinical data of 18 patients with ACC admitted to Jinhua Municipal People’s Hospital from January 2005 to January 2010 were retrospectively analyzed. The Cox proportional hazard model was used to perform univariate analysis and Kaplan- Meier method to calculate the survival rate of patients, the use of log-rank survival rate comparison, analysis of long-term prognosis and prognosis of patients. Results The median age of patients in this group was 48 years old (23 to 67 years). The median follow-up time for 18 patients was 75 months (range, 3 to 165 months). The 3-, 5-, and 10-year survival rates were 55.5%, 44.4%, and 16.7%, respectively. The median survival time was 46 months (1 to 158 months). Univariate analysis showed that the degree of tumor invasion and lymph node metastasis were associated with long-term prognosis (P = 0.02, 0.01). In addition, the 3-year, 5-year and 10-year disease-free survival rates were 55.5%, 33.3% and 33.3%, respectively. Univariate analysis showed that the degree of tumor invasion and lymph node metastasis were also related to disease free life cycle (P <0.01, P = 0.03). Conclusions Radical resection may provide a cure opportunity for ACC. The degree of tumor infiltration and lymph node metastasis are important factors affecting the prognosis of patients with ACC.