Outcome and prognostic factors after adrenalectomy for patients with distant adrenal metastasis

Abstract

Background: The purpose of this study was to describe a single-institution experience with adrenal metastasectomy and to elucidate factors that may bear prognostic significance.

Methods: This is a single-center, retrospective review of patients with adrenal metastasis who underwent adrenalectomy performed with curative intent between 2000 and 2012. The Kaplan-Meier method was used to evaluate overall survival from time of adrenalectomy to death or last follow-up. Primary endpoint was death from any cause. Clinical variables were examined for association with survival.

Results: The study included 62 patients with mean age of 60 (±12) years; 55 % (34 of 62) were male, 85 % (53 of 62) presented with isolated adrenal metastasis, and 82 % (51 of 62) had metachronous disease with median disease-free interval (DFI) of 22 months (range, 6-217 months). Non-small cell lung cancer (NSCLC) was the most common primary comprising 50 % of cases. Median survival for the study population was 30 months (range, 1-145 months) and 5-year survival was 31 %. Patients with NSCLC had significantly shortened survival compared with non-NSCLC with median and 5-year survival of 17 versus 47 months and 27 % versus 38 %, respectively (p = .033). Synchronous metastasis (p = .028) and DFI < 12 months (p = .038) were also associated with worse survival outcome, though male gender (p = .69) and oligometastatic disease (p = .62) were not.

Conclusions: Adrenal metastasectomy resulted in median survival of 30 months and 5-year survival of 31 %. Shorter survival was associated with lung primary, short disease-free interval, and synchronous metastasis, but not with the presence of oligometastatic disease provided that the primary cancer and additional metastatic lesions were adequately controlled and amenable to resection.

Figure 1

Kaplan-Meier survival estimates for study population by (a) lung vs. other primary malignancy, (b) synchronous vs. metachronous metastasis, (c) disease free interval < 12 vs. ≥ 12 months, (d) gender, and (e) isolated vs. oligometastatic disease.

Figure 1

Kaplan-Meier survival estimates for study population by (a) lung vs. other primary malignancy, (b) synchronous vs. metachronous metastasis, (c) disease free interval < 12 vs. ≥ 12 months, (d) gender, and (e) isolated vs. oligometastatic disease.

Figure 1

Kaplan-Meier survival estimates for study population by (a) lung vs. other primary malignancy, (b) synchronous vs. metachronous metastasis, (c) disease free interval < 12 vs. ≥ 12 months, (d) gender, and (e) isolated vs. oligometastatic disease.