Background: Adrenocortical carcinoma (ACC) commonly metastasizes to the lungs, and pulmonary metastasectomy (PM) is utilized due to limited systemic options. Methods: All ACC patients with initially only lung metastases (LM) from a single institution constituted this observational case series. Kaplan-Meier and Cox proportional hazard analyses evaluated the association with potential prognostic factors and outcomes. Overall survival (OS) was calculated from the date of the PM or, in those patients who did not undergo surgery, from the development of LM. Results: A total of 75 ACC patients over a 45-year period met the criteria; 52 underwent PM, and 23 did not. The patients undergoing PM had a median OS of 3.1 years (95% CI: 2.4, 4.7 years) with the 5- and 10-year OS being 35.5% and 32.8%, respectively. The total resected LM did not impact the OS nor the DFS. The patients who developed LM after 11 months from the initial ACC resection had an improved OS (4.2 years; 95% CI: 3.2, NR;p= 0.0096) compared to those developing metastases earlier (2.4 years; 95% CI: 1.6, 2.8). Patients who underwent PM within 11 months of adrenalectomy demonstrated a reduced OS (2.2 years; 95% CI: 1.0, 2.7) compared to those after 11 months (3.6 years, 95% CI: 2.6, NR;p= 0.0045). PM may provide benefit to those patients with LM at presentation (HR: 0.5;p= 0.2827), with the time to first PM as a time-varying covariate. Conclusions: PM appears to have a role in ACC patients. The number of nodules should not be an exclusion factor. Patients developing LM within a year of primary tumor resection may benefit from waiting before further surgeries, which may provide additional insight into who may benefit from PM.
背景：肾上腺皮质癌（ACC）常转移至肺部，由于全身性治疗方案有限，肺转移灶切除术（PM）被广泛应用。方法：本研究为观察性病例系列分析，纳入某单一机构所有初诊时仅发生肺转移（LM）的ACC患者。采用Kaplan-Meier法和Cox比例风险模型评估潜在预后因素与临床结局的关联性。总生存期（OS）计算起点为接受PM的日期，未手术患者则从出现LM开始计算。结果：45年间共75例ACC患者符合标准，其中52例接受PM，23例未手术。接受PM的患者中位OS为3.1年（95% CI：2.4-4.7年），5年和10年OS率分别为35.5%和32.8%。肺转移灶切除总数既不影响OS也不影响无病生存期（DFS）。与早期转移患者（2.4年；95% CI：1.6-2.8年）相比，初次ACC切除11个月后发生LM的患者OS显著改善（4.2年；95% CI：3.2-未达到；p=0.0096）。肾上腺切除术后11个月内接受PM的患者OS（2.2年；95% CI：1.0-2.7年）较11个月后手术者（3.6年；95% CI：2.6-未达到；p=0.0045）显著缩短。将首次PM时间作为时变协变量分析显示，PM可能使初诊即存在LM的患者获益（HR：0.5；p=0.2827）。结论：PM在ACC治疗中具有一定价值。转移结节数量不应作为手术排除标准。原发肿瘤切除一年内出现LM的患者，推迟后续手术可能获益，这为筛选PM获益人群提供了新思路。
Pulmonary Metastasectomy for Adrenocortical Carcinoma—Not If, but When
肿瘤(癌症)患者之家