肾上腺转移瘤的临床诊治体会(附55例报告)

Objective: To discuss the clinical characteristics of adrenal metastases, and summarize the experience of diagnosis and treatment. Methods: From January 2008 to June 2018, the clinical data of 55 patients with adrenal metastases treated in our hospital were analyzed retrospectively. This study included 34 male patients and 21 female patients and the median age was 60 years old (ranged 55 to 84 years old). The median value of maximum diameter of adrenal metastases was 3 cm (ranged 1.9 to 10.3 cm); with 35 cases on the left side, 13 cases right and 7 cases bilateral. The primary sites of malignant tumors were pancreas (18 cases, 32.7%), lung (12 cases, 21.8%), liver (6 cases, 10.9%) and colorectum (6 cases, 10.9%), respectively. Thirty-four cases were confirmed by pathology after adrenalectomy and 21 cases were confirmed by needle biopsy. Thirty cases were diagnosed synchronously with the primary tumor and 25 cases were metachronous. The median time from diagnosis of primary tumors was 13.3 months (ranged 2.0 to 97.4 months). 42 cases of these 55 cases were diagnosed within one year. Treatment options for adrenal metastatic lesions included single adrenalectomy in 18 cases, adrenalectomy combined with radiotherapy 16 cases, single intravenous chemotherapy 10 cases, intravenous chemotherapy combined with non-operative treatment 10 cases and single radiotherapy 1 case. Results: The main pathological types were adenocarcinoma (19 cases, 34.5%), ductal adenocarcinoma (10 cases, 18.2%), hepatocellular carcinoma (6 cases, 10.9%) and clear cell carcinoma (4 cases, 7.3%). Two cases were lost follow-up and the follow-up rate was 96%, the median follow-up time was 8 months (ranged 1 to 135 months). The median overall survival (OS) time of 55 patients was 5.3 months (ranged 1 to 134 months). The one-year survival rate was 23.6%(13/55), the two-year survival rate was 12.7%(7/55), the three-year survival rate was 9.1%(5/55) and the five-year survival rate was 1.8%(1/55). Conclusions: Pancreatic cancer was the most common type of malignant tumor for adrenal metastases in our hospital. Most primary tumors and adrenal metastases were diagnosed synchronously or within one year. Comprehensive treatment with retroperitoneal adrenalectomy may improve the OS, however the overall prognosis is poor.