ABSTRACT
Resumen Introducción: El carcinoma adrenocortical es una neoplasia endocrina infrecuente pero con un comportamiento altamente agresivo y pobre pronóstico. Dado su baja prevalencia, la experiencia de los centros de referencia es fundamental para aumentar el conocimiento de esta entidad. Métodos: Se elaboró una serie de casos de pacientes con carcinoma adrenocortical, tratados en una institución oncológica de referencia entre enero de 2007 y diciembre de 2017. Se describieron las características clínicas e histopatológicas de los pacientes. Se estimó el tiempo de supervivencia libre de progresión y el tiempo de supervivencia global (SG) de forma gráfica y con funciones de tiempo al evento mediante la función de Kaplan-Meier. Resultados: Se identificaron 19 pacientes, 14 de los cuales fueron mujeres con edad media al diagnóstico de 43.4 años (rango 20 - 65). El 58% de los pacientes tuvo secreción hormonal, siendo el síndrome de Cushing el predominante. 7 pacientes tuvieron compromiso metastásico al momento del diagnóstico. Todos los pacientes fueron llevados a adrenalectomía y el estado postquirúrgico en 10 pacientes fue R0. Al final del periodo de estudio, 11 pacientes estaban vivos. La mediana de supervivencia libre de progresión fue de 18 meses +/- 7.86 y la mediana de supervivencia global fue de 30 meses +/-19.80. Conclusión: En la población de pacientes analizada, se encontraron desenlaces de supervivencia libre de progresión y supervivencia global similares a lo reportado en centros de alta experiencia en patología adrenal.
Abstract Introduction: Adrenocortical carcinoma is a rare endocrine neoplasm, but with highly aggressive behavior and a poor prognosis. Given its low prevalence, the experience of reference centers is essential to characterize the factors associated with this disease. Methods: It is a case series of patients with adrenocortical carcinoma, treated at a reference oncology institute between January 2007 and December 2017. The clinical and histopathological characteristics of patients are described. Progression-free survival and overall survival (OS) were estimated graphically and with time-to-event data using the Kaplan-Meier function. Results: 19 patients were identified; 14 of them were women with a mean age at diagnosis of 43.4 years (range 20-65). 58% of the patients had hormone secretion, with Cushing's syndrome being the predominant one. 7 patients had metastatic compromise at the time of diagnosis. All patients underwent adrenalectomy, and R0 was the post-surgical status in 10 of them. At the end of the study period, 11 patients were alive. The median progression-free survival was 18 months +/- 7.86, and the median overall survival was 30 months +/- 19.8. Conclusion: In the analyzed patient population, outcomes of progression-free survival and overall survival were similar to that reported at centers with extensive experience in adrenal disease.
Subject(s)
Humans , Prognosis , Prevalence , Adrenocortical Carcinoma , Survival , SurvivorshipABSTRACT
Objective To investigate the expressions of Ki67,p53,CKL,EMA,S-lOO,NSE,CgA,Syn,CEA and nm23 in adrenal tumors and their clinical significance.Methods Clinical data from 157 cases of adre-nal tumor patients were retrospectively reviewed including the clinical informa-tion and pathology data.Expressions of Ki67,p53,CKL,EMA,S-100,NSE,CgA,Syn,CEA and nm23 proteins were studied by immunohistochemistry(SP method)using monoclonal antibodies,and the relationship of their expressions with histopathologic type and clinical imformation was analyzed with SAS v6.12 software.A P value of＜0.05 was considered statistically significant.Results A increase of the expression rate of CKL,S-100,NSE,CgA,Syn and nm23 in adrenal tumors was obsered(P＜0.05).For univariate analysis,the expression of S-100,CgA,Syn was in connection with histopathologie types(P＜0.05).The expression of S-100,CgA,Syn had positive correlation with each other.The expression of CKL,S-100,NSE,CgA,Syn,nm-23 was no difference between adrnalbenign tumors and malignant tumors(P＞0.05),but it was much higher than in normal adrenal tissues(P＜0.05).The expression of Syn in adrenal cortical adenomaa was higher than in adrenal cortical cancers(P＜0.05),the expression of Ki67 in adrenal cortical adenomas was much lower than in adrenal cortical cancers(P＜0.05).The expression of EMA、CKL in adrenal cortical tumors were higher than in adrenal medullary tumors(P＜0.05),the expression of S-100,Syn,NSE,CgA in adrenal cortical tumors were lower than in adrenal medullary tumors(P＜0.05).Conclusions CKL,S-100,NSE,CgA,Syn and nm23 were good markers for adrenal tumors,they could be use for the adrenal tumors diagnosis.Detect Syn and Ki67 simutaneously was helpful to the diagnosis of adrenal cortical tumors.Detect EMA,CKL,S-100,Syn,NSE and CgA simultaneously and combine with clinical data was helpful to diagnosis between adrenal cortical tumors and adrenal medullay tumors.In malignant tumors,blood pressure had positive correlation with the expression of CgA,the size of tumor had neg-ative correlation of blood pressure,no prognostic factor was found.