Adrenalectomy is commonly considered a curative treatment in case of adrenal gland as site of metastasis. In the present study, we evaluated the impact of primary tumor histology on survival outcomes after a minimally invasive adrenal mastectomy for a solitary metachronous metastasis. From May 2004 to August 2020, we prospectively collected data on minimally invasive adrenalectomies whose pathological examination showed a metastasis. All patients only received metastasectomies that were performed with curative intent, or to achieve non-evidence of disease status. Adjuvant systemic therapy was not administered in any case. Cancer-specific survival (CSS) was assessed using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were applied to identify independent predictors of CSS. Out of 235 laparoscopic and robotic adrenalectomies, the pathologic report showed metastases in 60 cases. The primary histologies included 36 (60%) renal cell carcinoma (RCC), 9 (15%) lung cancer, 6 (10%) colon cancer, 4 (6.7%) sarcoma, 3 (5%) melanoma and 2 (3.3%) bladder cancer. RCC displayed significantly longer survival rates with a 5-year CSS of 55.9%, versus 22.8% for other histologies (log-rankp= 0.01). At univariable analysis, disease-free interval (defined as the time from adrenalectomy to evidence of disease progression) < 12 months and histology were predictors of CSS (p= 0.003 andp< 0.001, respectively). At multivariable Cox analysis, the only independent predictor of CSS was primary tumor histology (p= 0.005); patients with adrenal metastasis from colon cancer and bladder cancer showed a 5.3- and 75.5-fold increased risk of cancer death, respectively, compared to patients who had RCC as primary tumor histology. Oncological outcomes of adrenal metastasectomies are strongly influenced by primary tumor histology. A proper discussion of the role of surgery in a multidisciplinary context could provide optimal treatment strategies.
肾上腺切除术通常被认为是肾上腺转移的根治性治疗方法。本研究评估了原发肿瘤组织学类型对孤立性异时性转移瘤行微创肾上腺切除术后生存结局的影响。自2004年5月至2020年8月，我们前瞻性收集了病理检查证实为转移瘤的微创肾上腺切除术病例数据。所有患者仅接受以根治为目的或为达到无疾病证据状态而实施的转移瘤切除术。所有病例均未接受辅助全身治疗。采用Kaplan-Meier法评估癌症特异性生存率（CSS）。通过单变量和多变量Cox回归分析确定CSS的独立预测因素。在235例腹腔镜及机器人肾上腺切除术中，病理报告显示60例为转移瘤。原发肿瘤组织学类型包括：36例（60%）肾细胞癌（RCC）、9例（15%）肺癌、6例（10%）结肠癌、4例（6.7%）肉瘤、3例（5%）黑色素瘤和2例（3.3%）膀胱癌。RCC患者生存率显著更长，其5年CSS为55.9%，而其他组织学类型为22.8%（时序检验p=0.01）。单变量分析显示，无病间期（定义为从肾上腺切除术到出现疾病进展的时间）<12个月和组织学类型是CSS的预测因素（p值分别为0.003和<0.001）。多变量Cox分析表明，CSS的唯一独立预测因素是原发肿瘤组织学类型（p=0.005）；与原发肿瘤为RCC的患者相比，结肠癌和膀胱癌来源的肾上腺转移患者癌症死亡风险分别增加5.3倍和75.5倍。肾上腺转移瘤切除术的肿瘤学结局受原发肿瘤组织学类型的显著影响。在多学科背景下对手术作用进行充分讨论，有助于制定最佳治疗策略。
Adrenalectomy for Metastasis: The Impact of Primary Histology on Survival Outcome
肿瘤(癌症)患者之家