Работа выполнена в соответствии с плановой НИР отделения хирургической эндокринологии ГБУЗ МО «Московский областной научно-исследовательский институт им. М. Ф. Владимирского» «Разработка инновационных технологий в диагностике, лечении, реабилитации и мониторинге пациентов с эндокринными опухолями», тема № 38 в разделе «Онкология». Учреждением, финансирующим исследование, является Министерство Здравоохранения Московской области. Авторы гарантируют ответственность за объективность представленной информации. Авторы гарантируют отсутствие конфликта интересов и собственной финансовой з аинтересованности. Рукопись поступила в редакцию 14.03.2018.
BACKGROUND: Adrenocortical carcinoma is a rare and aggressive disease. Tumor recurrence prevention is vital for increasing patients survival rate. Therefore, the identification of prognostic markers is of particular importance. AIM: To evaluate clinical, laboratory and chromatographic criteria for adrenocortical carcinoma recurrence using gas chromatography-mass spectrometry to optimize patients follow-up. MATERIALS AND METHODS: 40 patients [10 (25%) men and 30 (75%) women] with histologically confirmed adrenocortical carcinoma (according to the European Network for the Study of Adrenal Tumors stage I 3, II 29, III 8 patients at presentation) have been recruited. Measurement of 24-hour urinary steroid metabolite excretion has been carried out by gas chromatography-mass spectrometry (GCMS-ТQ8050, Shimadzu) in preoperative period. The survival distribution has been assessed according to the KaplanMeier method. Cox proportional hazards regression methods have been used to determine predictive factors on recurrence-free survival. RESULTS: The patients with early stages of disease (III versus III) had a significantly longer recurrence-free survival, overt hypercortisolism was associated with significantly shorter recurrence-free survival. A significant correlation between pregnenediol urinary excretion and tumor diameter, stage has been found. Increased urinary excretion of tetrahydro-11-deoxycortisol, pregnenediol was associated with a decreased recurrence-free survival in the patients with overt hypercortisolism. Increased urinary excretion of 16-OH-dehydroepiandrosterone was a marker of a shorter recurrence-free survival in the patients without Cushing syndrome. Increased urinary excretion of pregnenediol, pregnenetriol, 16-oxo-androstenediol in all the adrenocortical carcinoma patients was associated with a recurrence risk. In the multivariate analysis pregnenediol urinary excretion, stage and overt cortisol excess were significantly and independently associated with a shorter recurrence-free survival. CONCLUSIONS: Adrenocortical carcinoma recurrence prognostic markers have been found by gas chromatography-mass spectrometry. The application of these findings may improve patient-centered outcomes.
Работа выполнена в соответствии с плановой НИР отделения хирургической эндокринологии ГБУЗ МО «Московский областной научно-исследовательский институт им. М. Ф. Владимирского» «Разработка инновационных технологий в диагностике, лечении, реабилитации и мониторинге пациентов с эндокринными опухолями», тема № 38 в разделе «Онкология». Учреждением, финансирующим исследование, является Министерство Здравоохранения Московской области. Авторы гарантируют ответственность за объективность представленной информации. Авторы гарантируют отсутствие конфликта интересов и собственной финансовой заинтересованности. Рукопись поступила в редакцию 05.03.2018.
In the lecture on the basis of literature data and the results of our research deals with the basic aspects of insufficiently studied problems of metastatic adrenal tumors. Special attention is drawn to the modern algorithm of examination of these patients, the surgical treatment strategy and evaluation of long-term results. For the period from 1997 to 2016 in the surgical clinics of MONIKI operated on 56 patients with metastatic adrenal tumors (MAT). 22 MAT were synchronous, 36 — metachronous. From the 46 produced a «potentially radical» adrenalectomy with tumor (40 unilateral, 6 bilateral), 6 — partial removal of the MAT, in 4 open biopsy. 46 radically operated patients survival rates were analyzed in 37, the average follow-up period was 36.5 months. Overall and disease-free 5-year survival rate of patients with MAT was 46.8 % and 27.6 %, respectively. The most favorable results of surgical treatment of patients with isolated metastases of clear cell kidney cancer in the adrenal glands. Unilateral adrenalectomy is indicated for patients with solitary synchronous and metachronous tumors, total adrenalectomy — bilateral with isolated neoplastic lesions of the adrenal glands.
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