腹腔镜肾上腺切除术对非转移性肾上腺皮质癌患者的整体存活率的影响

腹腔镜肾上腺切除术对非转移性肾上腺皮质癌患者的整体存活率的影响
Impact of Laparoscopic Adrenalectomy on Overall Survival in Patients with Nonmetastatic Adrenocortical Carcinoma

Abstract
BACKGROUND:
Appropriate use of laparoscopic adrenalectomy (LA) for adrenocortical carcinoma (ACC) remains controversial because complete resection with negative margins is the best chance for potential cure. This study compared the oncologic outcomes and overall survival (OS) of LA and open adrenalectomy (OA) for ACC.
摘要
背景：
适当使用腹腔镜肾上腺切除术（LA）肾上腺皮质癌（ACC）仍有争议，因为负的利润完全切除是可能治愈的最佳机会。本研究比较和总生存（OS）的肿瘤学结果LA和开放手术（OA）为中心

STUDY DESIGN:
A retrospective analysis of the National Cancer Data Base (NCDB) between 2010 and 2014 identified 423 European Network for the Study of Adrenal Tumors (ENSAT) stage I to III ACC patients who had LA (n = 137) or OA (n = 286). Outcomes and OS were compared between the 2 groups.
研究设计：
一个国家癌症数据库的回顾性分析（NCDB）2010和2014确定了423个欧洲网络肾上腺肿瘤的研究（ensat）I至III期ACC患者（n = 137）或LA OA（n = 286）。2组的结果和操作系统进行了比较。

RESULTS:
Patients who underwent OA had more advanced stage disease (p = 0.0001), larger (≥5 cm) tumors (p < 0.0001), and were younger (age less than 55 years, p = 0.05). Nodal assessment was rare in LA (n = 4) compared with OA (n = 88) (p < 0.0001). Margin positivity was affected only by surgical approach in patients with T3 tumors (LA 54.6% vs OA 21.7%; p = 0.0009). Neither surgical procedure nor any socio-demographic factor(s) affected OS for the entire cohort. Only positive margins (p = 0.007), positive nodes (p = 0.02), tumor extension (p = 0.01), and more advanced ENSAT stage (p = 0.004) increased mortality. When stratified by disease stage, LA decreased OS for patients with stage II disease (p = 0.04), and remained an independent risk factor for death on multivariate analysis (hazard ratio [HR] 1.86, 95% CI 1.02 to 3.38; p = 0.04). Only positive margins decreased OS in the entire cohort (HR 2.17, 95% CI 1.32 to 3.57; p = 0.002).
结果:
患者接受开放更高级阶段的疾病（P = 0.0001），大（≥5厘米）肿瘤（P＜0.0001），与年轻（年龄小于55岁，P = 0.05）。在LA（n = 4）与骨关节炎（N = 88）（P = 0.0001）（P =），节点评估是罕见的。缘阳性只有T3肿瘤患者手术方式的影响（LA 54.6%与OA 21.7%；P = 0.0009）。无论是外科手术，也没有任何社会人口因素（S）受影响的操作系统的整个队列。只有积极的利润率（P = 0.007），淋巴结阳性（P = 0.02），肿瘤扩展（P = 0.01），和更先进的ensat阶段（P = 0.004）死亡率增加。当分层的疾病阶段，LA下降的患者的II期疾病（P = 0.04），并仍然是一个独立的死亡危险因素的多因素分析（危险比（人力资源）1.86，95%可信区间为1.02至3.38；P = 0.04）。只有积极的利润率下降，在整个队列（人力资源2.17，95%可信区间为1.32至3.57；P = 0.002）。

CONCLUSIONS:
Use of LA may decrease OS in select patients with ACC. Because margin status remains the strongest predictor of mortality, caution should be used in selecting LA for patients with ACC.
结论：
利用LA可能会减少公司在选择患者OS因为边缘状态是最强的预测死亡率，应谨慎使用，在选择LA治疗中心

英文原文：
Impact of Laparoscopic Adrenalectomy on Overall Survival in Patients with Nonmet.pdf (393.4 KB, 下载次数: 0, 售价: 99 香叶)

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腹腔镜肾上腺切除术对非转移性肾上腺皮质癌患者的整体存活率的影响