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目的:分析非小细胞肺癌(non-small cell lung cancer,NSCLC)合并孤立性肾上腺转移瘤患者预后及其影响因子。方法:回顾分析中山大学附属第三医院2001-01-01-2010-12-31收治的NSCLC合并孤立性肾上腺转移瘤患者住院及随访资料,用Kaplan-Meier法及Cox模型分析生存情况,筛选临床基线、治疗方式、病理类型、原发灶及转移瘤特征等预后影响因素。结果:NSCLC合并孤立性肾上腺转移的患者共计22例,总体中位生存时间11个月(9.4~12.6个月),1年生存率51.4%(29.6%~73.2%)。10例患者接受了肺部病灶及肾上腺转移瘤切除术,12例患者采取保守治疗,手术组与保守治疗组中位生存时间分别为9和12个月,差异无统计学意义,P=0.209。单因素分析显示,不同ECOG评分患者间存在生存差异,各分值对应中位生存期为0分14个月,1分11个月,2分8个月,3分6个月,P=0.024。多因素分析显示,仅ECOG评分进入Cox比例风险方程,P=0.033,RR=1.95。结论:ECOG评分及病理类型可能是孤立性肾上腺转移NSCLC患者预后的影响因素。对于ECOG评分差、合并N2纵隔淋巴结转移者,手术治疗应慎重考虑。
Objective: To analyze the prognosis and its influencing factors in patients with solitary adrenal metastases of non-small cell lung cancer (NSCLC). Methods: The hospitalization and follow-up data of patients with solitary adrenal metastasis of NSCLC admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2001 to October 2010 were retrospectively analyzed. Survival was analyzed by Kaplan-Meier method and Cox model, Baseline, treatment, pathological type, primary tumor and metastasis characteristics of prognostic factors. Results: A total of 22 NSCLC patients with isolated adrenal metastases had a median overall survival of 11 months (9.4-12.6 months) and one-year survival rates of 51.4% (29.6% -73.2%). Ten patients underwent lung lesions and adrenalectomy, and conservative treatment was performed in 12 patients. The median survival time was 9 and 12 months in the surgical and conservative groups, respectively, with no significant difference (P = 0.209). Univariate analysis showed that there were differences in survival between patients with different ECOG scores. The corresponding median survival time was 0:14 months, 1 minute, 11 months, 2 minutes and 8 months, 3 minutes and 6 months, P = 0.024 . Multivariate analysis showed that only ECOG scores entered the Cox proportional hazards equation with P = 0.033 and RR = 1.95. Conclusion: ECOG score and pathological type may be the prognostic factors in patients with solitary adrenal metastasis of NSCLC. For poor ECOG score, combined with N2 mediastinal lymph node metastasis, surgical treatment should be carefully considered.