围手术期参数用于鉴别大体积肾上腺皮质癌与肾上腺节细胞神经瘤:一项回顾性队列研究OA

Objective:Adrenocortical carcinoma(ACC)and adrenal ganglioneuroma(AGN)are both large adrenal tumors.Given the substantial differences in treatment strategies and prognosis between these 2 entities,accurate preoperative differentiation is essential for developing individualized and appropriate treatment plans.This study aims to compare perioperative parameters between patients with ACC and AGN,identify variables with discriminatory value,and evaluate their clinical significance,thereby providing a reference for the preoperative diagnosis of ACC. Methods:Clinical data of patients diagnosed with ACC or AGN at The First Affiliated Hospital of University of Science and Technology of China or The First Affiliated Hospital of Anhui Medical University between March 2005 and April 2021 were retrospectively reviewed.According to postoperative pathological findings,patients were assigned to the ACC group or AGN group.Baseline characteristics(including age,gender,height,weight,history of hypertension,and history of diabetes),preoperative findings(including maximum tumor diameter,tumor laterality,white blood cell count,red blood cell count,fibrinogen level,and other hematological and imaging parameters),and postoperative data(including operative time,intraoperative blood loss,postoperative complications,and pathological findings)were compared between the 2 groups.Variables showing statistically significant differences were entered into logistic regression analysis to identify independent predictors of postoperative pathological diagnosis of ACC in patients with large adrenal tumors.Receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic performance of each predictor. Results:A total of 43 patients were included,comprising 25 patients in the ACC group and 18 patients in the AGN group.No significant differences were observed between the 2 groups with respect to age,sex,history of hypertension,history of diabetes,body mass index(BMI),tumor laterality,or preoperative unenhanced CT attenuation values(all P>0.05).The maximum tumor diameter was significantly larger in the ACC group than in the AGN group(P<0.05).Compared with the AGN group,patients in the ACC group had significantly higher levels of white blood cells,neutrophils,monocytes,platelet counts,fibrinogen,blood glucose,globulin,red cell distribution width(RDW),and plateletcrit,while albumin levels and platelet distribution width were significantly lower(all P<0.05).Operative time was longer,and intraoperative blood loss was greater in the ACC group than in the AGN group(both P<0.05).The incidence of postoperative fever was also significantly higher in the ACC group(P<0.05).Using postoperative pathological diagnosis of ACC as the dependent variable,logistic regression analysis demonstrated that white blood cell count,RDW,and fibrinogen level were independent predictors of postoperative pathological diagnosis of ACC in patients with large adrenal tumors(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)values for white blood cell count,RDW,and fibrinogen level were 0.737(95％CI 0.588 to 0.885),0.793(95％CI 0.656 to 0.931),and 0.830(95％CI 0.709 to 0.951),respectively.The optimal cut-off values were 6.67×109/L,41.20％,and 3.04 g/L,respectively,with corresponding sensitivities of 60.00％,76.00％,and 64.00％,and the specificities of 83.30％,77.80％,and 94.40％,respectively. Conclusion:In patients with large adrenal tumors,preoperative white blood cell count>6.67×109/L,RDW>41.20％,and fibrinogen level>3.04 g/L should raise strong suspicion for ACC.For such high-risk patients,a more comprehensive perioperative management strategy should be implemented to reduce surgery-related risks and improve overall prognosis.