Prognostic parameters of metastatic adrenocortical carcinoma

被引:173
作者
Assie, Guillaume
Antoni, Guillemette
Tissier, Frederique
Caillou, Bernard
Abiven, Gwenaelle
Gicquel, Christine
Leboulleux, Sophie
Travagli, Jean-Paul
Dromain, Clarisse
Bertagna, Xavier
Bertherat, Jerome
Schlumberger, Martin
Baudin, Eric
机构
[1] Univ Paris 11, Inst Gustave Roussy, Dept Sante Publ, F-94800 Villejuif, France
[2] Univ Paris 11, Inst Gustave Roussy, Dept Anatomopathol, F-94800 Villejuif, France
[3] Univ Paris 11, Inst Gustave Roussy, Serv Med Nucl & Cancerol Endocrinienne, F-94800 Villejuif, France
[4] Univ Paris 05, Hop Cochin, Dept Anatomopathol, Fac Med, F-75014 Paris, France
[5] Univ Paris 05, Hop Cochin, Serv Endocrinol, Fac Med, F-75014 Paris, France
[6] Inst Cochin Genet Mol, UMR 8104, CNRS, F-75014 Paris, France
[7] INSERM U567, Dept Endocrinol Metab Canc, F-75014 Paris, France
[8] Univ Paris 06, Hop Armand Trousseau, INSERM U515, Lab Explorat Fonct Endocriniennes, F-75012 Paris, France
关键词
D O I
10.1210/jc.2006-0706
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Prognostic parameters of metastatic adrenocortical carcinoma (ACC) are poorly characterized. Objective: The objective of the study was to describe the clinical presentation of metastatic ACC and determine prognostic factors for survival. Design: This was a retrospective cohort study (1988-2004). Setting: The study was conducted in an institutional practice. Patients: Participants included 124 consecutive patients with metastatic ACC, 70 from Gustave-Roussy Institute (main cohort) and 54 patients from the Cochin Hospital (validation cohort). Clinical data concerning all patients, histopathologic slides of primary tumors (44 in the main cohort and 40 in the validation cohort), and molecular biology data on 15 primary tumors (main cohort) were analyzed. Intervention: There was no intervention. Main Outcome: The main outcome was the specific survival after discovery of the first metastasis (Kaplan-Meier method). This included univariate analysis on the main cohort, confirmed on the validation cohort and then analyzed in a multivariate analysis. Results: In the main cohort, overall median survival was 20 months. In univariate analysis, the presence of hepatic and bone metastases, the number of metastatic lesions and the number of tumoral organs at the time of the first metastasis, a high mitotic rate (> 20 per 50 high-power field), and atypical mitoses in the primary tumor predicted survival (P = 0.05, 0.003, 0.046, 0.001, 0.01, and < 0.001, respectively). The number of tumoral organs and a high mitotic rate were confirmed on the validation cohort (P = 0.009 and 0.03, respectively). These two parameters were confirmed in multivariate analysis (P = 0.0058 and 0.049). Conclusion: Metastatic ACC is a heterogeneous disease with poor outcome. The combination of the number of tumoral organs at the time of the first metastasis and the mitotic rate can predict different outcomes.
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页码:148 / 154
页数:7
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