副腎皮質癌7例の治療成績

Treatment of adrenocortical carcinoma：Results in a consecutive series of 7 patients

　7例の副腎皮質癌の治療成績について報告する。対象は臨床病期stage Ⅰ 2例，stage Ⅱ 1例，stage Ⅲ 1例，stage Ⅳ 3例である。stage Ⅰ症例に対し腹腔鏡下手術，stage Ⅱ症例に開腹手術を施行した。Stage Ⅲ，Ⅳ症例は1例を除きミトタン投与と経カテーテル動脈塞栓を行った。うち1例はシスプラチンを中心とした化学療法を併用した。Stage Ⅰ例はおのおの33か月，42か月間無病生存したが，stage Ⅱ以上の5例は6～30か月間ですべて癌死した。全7例の累積生存率は28.6％，生存期間中央値は17か月であった。副腎皮質癌の治療においては，治癒切除の得られる手術療法が最も重要であると思われた。

　We reviewed the records of 7 patients with adrenocortical carcinoma（ACC）who had been managed in our institution between 2001 and 2008. Two clinical stage Ⅰ patients,one clinical stage Ⅱ patient,one clinical stage Ⅲ patient,and three clinical stage Ⅳ patients were analysed. Stage Ⅰ patients underwent laparoscopic adrenalectomy,stage Ⅱ patient had open surgery. Stage Ⅲ and Ⅳ patients except one were treated with mitotane and transcatheter embolization. Combined chemotherapy consisting of cisplatine was administered to one stage Ⅳ patient. Stage Ⅰ patients have lived with disease free for 33,and 42 months,but other patients died within 6 to 30 months. The median survival of all 7 patients was 17 months,and the overall survival rate was 28.6％. Surgical radical resection is thought to be most important and significantly influences the prognosis of ACC.