摘要目的 分析肾上腺转移瘤的临床特点,总结诊治经验.方法 回顾性分析2008年1月至2018年6月我院收治的55例肾上腺转移瘤患者的临床资料.男34例,女21例;中位年龄60岁(55～84岁).肾上腺转移瘤的最大径中位值为3.0 cm(1.9～10.3 cm);左侧35例,右侧13例,双侧7例.肾上腺转移瘤增强CT检查表现为“快进慢出”的特征.55例肿瘤原发部位依次为胰腺18例,肺12例,肝脏6例,结直肠6例,腹膜后肿物4例,肾4例,胃4例,子宫1例.34例经手术切除肾上腺组织病理证实;21例经细针穿刺活检组织病理证实.30例肾上腺转移瘤与原发灶同期确诊;25例为原发恶性肿瘤确诊后诊断,距离原发肿瘤诊断的中位时间为13.3个月(2.0 ～97.4个月);55例中42例为原发肿瘤诊断后1年内确诊断.治疗方案包括:后腹腔镜下患侧肾上腺切除18例;后腹腔镜下患侧肾上腺切除联合放疗16例;静脉化疗10例;静脉化疗联合非手术治疗(外放疗、粒子置入内放疗)10例;外放疗1例.结果 55例病理类型:腺癌19例,导管腺癌10例,肝细胞癌6例,透明细胞癌4例,腺鳞癌4例,脂肪肉瘤3例,横纹肌肉瘤2例,导管细胞癌、低分化导管腺癌、宫颈鳞状细胞癌、肺鳞状细胞癌、肺小细胞癌、弥漫性大B细胞淋巴瘤、小细胞神经内分泌癌各1例.本组55例中失访2例,随访率96％,随访中位时问为8个月(1～135个月).患者的总生存时间(OS)中位值为5.3个月(1 ～ 134个月),1、2、3、5年的总生存率分别为23.6％(13/55)、12.7(7/55)、9.1％ (5/55)、1.8％(1/55).34例接受肾上腺切除术患者的中位OS为4.5个月(1.0～ 134.0个月),其中18例仅行手术治疗的患者中位OS为2.0个月(1.0 ～53.0个月);16例手术联合放化疗的患者中位OS为7.2个月(1.2～134.0个月).21例未行手术治疗的患者中位OS为7.9个月(1.0 ～47.3个月).结论 肾上腺转移瘤的原发病在我院以胰腺癌最常见,多数在原发肿瘤发现的同期或1年内诊断.后腹腔镜下患侧肾上腺切除术联合化疗、放疗等的综合治疗可能延长患者的生存期,但总体预后差.

abstractsObjective 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.