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目的分析临床诊断为肾上腺无功能瘤(NFA)患者的术后病理结果,探讨其适合手术治疗的瘤体直径最佳切点。方法收集1996年2月至2016年1月在解放军总医院内分泌科评估为NFA、同时于本院泌尿外科手术治疗且资料齐全的243例患者的临床资料。根据病理结果是否真正需要手术治疗分为需要手术组(57例)和无需手术组(186例),分析两组患者一般情况、病理类型、肿瘤直径和影响判断NFA是否需要手术治疗的因素,绘制NFA直径ROC曲线,获得灵敏度与特异度之和最大的手术最佳切点。结果 57例需要手术的患者中,男27例、女30例,瘤体位于右侧31例、左侧25例、双侧1例,直径中位数为4.5cm,就诊年龄18~71(41.5±12.1)岁。186例无需手术组中,男87例、女99例,瘤体位于右侧99例、左侧86例、双侧1例,直径中位数为3.0cm,就诊年龄13~76(50.6±10.9)岁。Logistic回归分析示瘤体直径可能是肾上腺无功能瘤需要手术的危险因素(OR=1.340,95%CI 1.266~1.418,P=0.000),年龄可能是保护因素(OR=0.942,95%CI 0.929~0.955,P=0.000)。ROC曲线下面积(AUC)为0.757(95%CI 0.681~0.833),以瘤体直径4.1cm作为NFA手术切点时,Youden指数最大(灵敏度60.7%,特异度83.0%)。结论 NFA直径较大的年轻患者需要采取手术治疗的可能性较大。以直径4.1cm作为NFA患者的手术切点最佳。
Objective To analyze the postoperative pathological results of clinically diagnosed non-adrenal aneurysm (NFA) patients and to explore the best cut-point of the tumor diameter suitable for surgical treatment. Methods The clinical data of 243 patients with complete data which were evaluated as NFA by Department of Endocrinology of People’s Liberation Army General Hospital from February 1996 to January 2016 were also collected in Department of Urology. According to the pathological results whether the need for surgical treatment is divided into the need for surgery group (57 cases) and no surgery group (186 cases), the general situation of two groups of patients, pathological type, tumor diameter and influence factors to determine whether NFA need surgical treatment, draw NFA diameter ROC curve, access to the sensitivity and specificity and the largest surgical best cut point. Results There were 27 males and 30 females in 57 cases. The tumors were located on the right side in 31 cases, the left side in 25 cases and the bilateral ones in 1 case. The median diameter was 4.5 cm and the age of treatment was 18 to 71 (41.5 ± 12.1) years old. There were 87 males and 99 females in the 186 cases without surgery. The tumors were located on the right side in 99 cases, the left side in 86 cases and the double side in 1 case. The median diameter was 3.0 cm and the age of diagnosis was from 13 to 76 (50.6 ± 10.9) )year old. Logistic regression analysis showed that the diameter of the tumor may be the risk factor of surgery for adrenal non-functioning tumor (OR = 1.340,95% CI 1.266-1.418, P = 0.000), and the age may be the protective factor (OR = 0.942,95% CI 0.929 ~ 0.955, P = 0.000). The area under the ROC curve (AUC) was 0.757 (95% CI 0.681-0.833). When the diameter of the tumor was 4.1cm, the Youden index was the highest (sensitivity 60.7%, specificity 83.0%). Conclusion Young patients with larger NFA diameters are more likely to need surgery. 4.1cm diameter as the NFA patients with the best surgical site.