Predictive Characteristics of Malignant Pheochromocytoma
박준수, 송채린, 박명찬, 유상준, 박세준, Hong Seok-Jun, 홍범식, 김청수, 안한종,
소속 상세정보
박준수 ( Park Jun-Soo )
University of Ulsan College of Medicine Department of Urology
송채린 ( Song Che-Ryn )
University of Ulsan College of Medicine Department of Urology
박명찬 ( Park Myung-Chan )
University of Ulsan College of Medicine Department of Urology
유상준 ( Yoo Sang-Jun )
University of Ulsan College of Medicine Department of Urology
박세준 ( Park Se-Jun )
University of Ulsan College of Medicine Department of Urology
( Hong Seok-Jun )
University of Ulsan College of Medicine Department of General Surgery
홍범식 ( Hong Bum-Sik )
University of Ulsan College of Medicine Department of Urology
김청수 ( Kim Choung-Soo )
University of Ulsan College of Medicine Department of Urology
안한종 ( Ahn Han-Jong )
University of Ulsan College of Medicine Department of Urology
KMID : 0358320110520040241
Abstract
Purpose: The prognosis of patients with malignant pheochromocytoma is poor, but the predictive factors are not well understood. We aimed to identify the clinical characteristics predictive of malignancy after initial surgical removal in patients with pheochromocytoma.
Materials and Methods: We retrospectively reviewed the records of 152 patients diagnosed with pheochromocytoma, including 5 (3.3%) with metastasis at the time of the initial surgical excision and 12 (7.9%) who developed metastasis during follow-up. To determine the factors predictive of malignancy, we compared clinical, radiographical, and urinary chemical findings between patients with benign and malignant disease. Mean follow-up was 41.5 months (range, 0.9-298 months) after surgery.
Results: Malignant tumors were significantly larger than benign tumors (11.1±4.0 cm vs. 6.2±3.4 cm, p<0.001), and postoperative persistence of arterial hypertension was more frequent after removal of malignant than benign tumors (p=0.001). Among the 147 patients without metastatic disease at diagnosis, those who developed metastasis had significantly lower concentrations of urinary catecholamine metabolites per unit of tumor, including vanillylmandelic acid (1.2 vs. 3.7 mg/day/cm, p=0.049), epinephrine (4.5 vs. 168.9 μg/day/cm, p=0.008), and norepinephrine (13.1 vs. 121.8 mg/day/cm, p<0.001). The overall 5-year metastasis-free survival rate was 84.4% and was significantly higher in patients with smaller tumors (≤5.5 vs. >5.5 cm; 90.6% vs. 81.2%, p=0.025) and higher 24-hour secretion of vanillylmandelic acid (>2.1 vs. ≤2.1 mg/day/cm; 94.9% vs. 70.9%, p=0.019).
Conclusions: Large tumor size (>5.5 cm) and minimally elevated 24-hour urinary vanillylmandelic acid (≤2.1 mg/day/cm) were significantly associated with a higher probability of a malignant pheochromocytoma portending a lower metastasis-free survival and mandating more rigorous follow-up after surgery.
키워드
Adrenal gland neoplasms; Catecholamines; Pheochromocytoma; Tumor burden
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