Faut-il opérer les métastases surrénaliennes isolées des cancers bronchopulmonaires non à petites cellules ?

Abstract

No consensus yet governs management of solitary adrenal metastasis of non-small cell lung cancer (NSCLC). Although classically considered incurable, various case reports and small series indicate that surgical treatment may improve long-term survival. The aim of this study was to review our experience and to identify factors that may affect survival. From January 1989 through June 2006, 26 patients (21 men and 5 women; mean age: 54+/-10 years) underwent complete resection of an isolated adrenal metastasis after surgical treatment of NSCLC. The adrenal metastasis was diagnosed at the same time as the NSCLC in 6 patients and subsequently in 20 patients. Median disease-free interval for patients with metachronous metastasis was 13.8 months (range: 4.5 to 60.1 months). The overall 5- and 10-year survival rates were 31 and 21% respectively. Univariate and multivariate analysis showed that a disease-free interval longer than 6 months was a significant independent predictor of longer survival in patients after adrenalectomy. All patients with a disease-free interval of less than 6 months died within 2 years of surgery. After resection of an isolated adrenal metastasis diagnosed more than 6 months after lung resection, the 5-year survival rate was 49%. Adjuvant therapy and pathological staging of NSCLC did not affect survival. Surgical resection of subsequent isolated adrenal metastasis with a disease-free interval longer than 6 months can lead to long-term survival in patients with previous complete resection of the primary NSCLC.