Outcome and Prognostic Factors After Adrenalectomy for Patients with Distant Adrenal Metastasis

Abstract

The purpose of this study was to describe a single-institution experience with adrenal metastasectomy and to elucidate factors that may bear prognostic significance. 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. 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 22months (range, 6-217months). Non-small cell lung cancer (NSCLC) was the most common primary comprising 50% of cases. Median survival for the study population was 30months (range, 1-145months) 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 47months and 27% versus 38%, respectively (p=.033). Synchronous metastasis (p=.028) and DFI<12months (p=.038) were also associated with worse survival outcome, though male gender (p=.69) and oligometastatic disease (p=.62) were not. Adrenal metastasectomy resulted in median survival of 30months 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.