부산대학교 도서관

Simple Summary: The adrenal gland is often the site of metastasis coming from different primary tumors, including lung, kidney, breast, gastrointestinal cancer and melanoma. Metastasis-directed therapy is not yet well standardized and a multidisciplinary assessment is relevant for planning adequate management. Minimally invasive adrenalectomy is the most common treatment option, and many reports are available in the literature, demonstrating its feasibility. Previous studies showed increased survival in selected patients treated who had an adrenalectomy for metastasis, but all these findings remained inconsistent due to heterogeneous baseline clinical conditions, primary histology and tumor staging. Therefore, further investigations are needed to define the ideal candidate for adrenal metastasectomy in case of oligometastatic diseases. In the present report, we present the oncological outcome of a minimally invasive adrenalectomy for isolated adrenal metastasis, and the impact of primary histology on cancer-specific survival probability. 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-rank p = 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 and p < 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. [ABSTRACT FROM AUTHOR]