(OR= %CI 1.266~1.418 P=0.000) 4.1cm NFA. [DOI] /j.issn

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1 [ ] (NFA) NFA 243 (57 ) (186 ) NFA NFA ROC cm 18~71(41.5±12.1) cm 13~76(50.6±10.9) Logistic (OR= %CI 1.266~1.418 P=0.000) (OR= %CI 0.929~0.955 P=0.000) ROC (AUC) 0.757(95%CI 0.681~0.833) 4.1cm NFA Youden ( 60.7% 83.0%) NFA 4.1cm NFA [ ] [ ] R736.6 [ ] A [ ] (2016) [DOI] /j.issn suitable for surgery LIU Dan-dan, LI Le-le, DOU Jing-tao *, HAN Bai-yu, ZANG Li, JIN Nan, GU Wei-jun, DU Jin, YANG Li-juan, BA Jianming, LV Zhao-hui, LU Ju-ming, MU Yi-ming Department of Endocrinology, Key Laboratory of Endocrinology and Metabolism of PLA, Chinese PLA General Hospital, Beijing , China * Corresponding author, jingtaodou@ sohu.com [Abstract] Objective To analyze the pathology of the patients with nonfunctional adrenal tumor (NFA), and explore the optimal diameter cut-off value. Methods The clinical data of 243 patients with NFA, evaluated in the Department of Endocrinology and operated in the Department of Urology of General Hospital of Chinese PLA from Feb to Jan. 2016, were collected. The patients were divided into two groups according to pathology: those in real demand of surgery were classified to the surgery-need group (n=57), while the others were categorized as the surgery-unwanted group (n=186). The general situation, pathological type and tumor diameter of the two groups and the factors affecting the surgery were analyzed, and the ROC curve was used to explore the optimal surgery cut-off value, which represents the maximum value of the sum of sensitivity and specificity. Results Of the 57 patients in surgery-need group (27 males and 30 females), the lesions were on the right in 31 cases, on the left in 25 cases, and on bilateral sides in 1 case; the median of lesion diameter was 4.5cm, and the average age was 41.5±12.1 years old. Of the 186 patients in surgery-unwanted group (87 males and 99 females), the lesions were on the right in 99 cases, on the left in 86 cases, and on bilateral sides in 1 case; the median of lesion diameter was 3.0cm, and the average age was 50.6±10.9 years old. Logistic regression revealed that lesion diameter might be a risk factor (OR=1.340, 95%CI , P=0.000) and age be a protective factor (OR=0.942, 95%CI , P=0.000) for real demand of surgery. The area under the ROC curve (AUC) of lesion diameter was 0.757(95%CI ). The optimal cut-off value was 4.1cm (sensitivity 60.7% and specificity 83.0%). Conclusions Younger patients with bigger lesion diameter may have greater possibility for surgery. The optimal surgery cut-off value of the lesion diameter is 4.1cm. [Key words] adrenocortical adenoma; endocrine surgical procedures; lesion diameter [ ] [ ] ( ) [ ] jingtaodou@sohu.com

2 Med J Chin PLA, Vol. 41, No. 11, November 1, (nonfunctional adrenal tumor NFA) 49.9% [1] NFA 2009 (AACE) (AAES) [2] CT 4cm NFA 80% NFA NFA NFA NFA NFA [3-14] [15-19] (ACTH-F) 1mg (1mg DST) <50nmol/L 24h (24h UFC) 2 24h (NE) (E) (DA) / (pmol/l)/ [ g/(l.h)] (ARR)<30 CT CT 10Hu 20~40Hu CT 80~90Hu 10~15min 50% [2] [20] 1.3 SPSS 17.0 x±s t ( Q) (%) χ 2 Logistic ROC P< (47.4%) 30 (52.6%) 31 (54.4%) 25 (43.9%) 1 (1.8%) 18~71(41.5±12.1) (46.8%) 99 (53.2%) 99 (53.2%) 86 (46.2%) 1 (0.5%) 13~76(50.6±10.9) (P<0.05) ( 1) (Q=3.25)cm

3 Tab.1 Comparison of general conditions between two groups Item Surgery-need group (n=57) Surgery-unwanted group (n=186) t-value/χ 2 -value P-value Gender (Male/Female) 27/30 87/ Lesion location (Right/Left/Bilateral) 31/25/1 99/86/ Visiting ages (x±s, year) 41.5± ± Tab.2 Distribution of pathological pattern and grouping status of 243 patients with NFA Surgery-need group Case Excised lesion number Surgery-unwanted group Case Excised lesion number Total number Total number Malignant lymphoma 2 5 Adenoma sebaceum (one case accompanied by cystic change) Liposarcoma 1 1 Myelolipoma Cortical carcinoma 1 1 Hydatoncus (one case is epidermoid cyst) Pheochromocytoma Adrenal hyperplasia 5 6 Ganglioneuroma Hematoma 3 3 Neurinoma 4 4 Hematolymphangioma (one case accompanied by partial calcification) 2 2 Neurofibroma 2 2 Lymphangioma 2 2 Adenoma tumor (One case accompanied a large number of necrosis) 3 3 Cavernous hemangioma (One case accompanied hematoma) 3 3 Perivascular epithelioid cell tumor 2 2 Angiomyolipoma 1 1 Mature cystic teratomas 1 1 Adrenal hyperplasia with bleeding (Q=1.85)cm (Mann-Whitney U= Z= P=0.000) 20.0 Lesion diameter (cm) cm 0.0 Surgery-need group Surgery-unwanted group 1 Fig.1 Comparison of contribution of the lesion diameters between two groups 2.3 NFA Logistic NFA (OR= %CI 1.266~1.418 Wals = P=0.000) (OR= %CI 0.929~0.955 Wals = P=0.000) NFA ( =1.667 P=0.197) ( =0.316 P=0.574) 2.4 ROC ( 2) ROC (AUC) 0.757(95%CI 0.681~0.833) (0.5) 4.1cm Sensitivity Specificity 2 ROC Fig.2 ROC curve taking postoperative pathology as diagnosis index

4 Med J Chin PLA, Vol. 41, No. 11, November 1, Youden ( % 83.0%) 43.7% 3 4cm 68.9% 70.6% Youden 39.5% 3 Youden (%) Tab.3 Sensitivity, specificity and Youden index of NFA with different surgery cut-off value (%) Surgery cut-off value (cm) Sensitivity Specificity Youden index NFA [21] 19 3 [3-8] [9] [10-11] [12-13] [14] [15-16] [17-18] [19] ROC 4.1cm 2000 Mantero [22] 1004 >4cm 73% >4cm ROC 4cm 2009 AACE/AAES 4cm [2] 2012 Wang [23] CT MRI <4cm ( ) <65 >4cm 4cm 4.1cm Youden 39.5% 4.1cm Youden (43.7%) Cho [24] 243 NFA % AACE/AAES 3~6 1~2 5 1cm [2] NFA 4.1cm

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