Surgical Treatment of Adrenal Disease
The clinical experience of diagnosis and treatment on adrenal metastases(report of 55 cases)
Juping Zhao, Alimu Parehe·, Hongchao He, Fukang Sun, Wei He, Xin Huang, Jun Dai, Le Xu, Chen Fang, Danfeng Xu
Published 2019-04-15
Cite as Chin J Urol, 2019, 40(4): 272-276. DOI: 10.3760/cma.j.issn.1000-6702.2019.04.008
Abstract
ObjectiveTo discuss the clinical characteristics of adrenal metastases, and summarize the experience of diagnosis and treatment.
MethodsFrom January 2008 to June 2018, the clinical data of 55 patients with adrenal metastases treated in our hospital were analyzed retrospectively. This study included 34 male patients and 21 female patients and the median age was 60 years old (ranged 55 to 84 years old). The median value of maximum diameter of adrenal metastases was 3 cm (ranged 1.9 to 10.3 cm); with 35 cases on the left side, 13 cases right and 7 cases bilateral. The primary sites of malignant tumors were pancreas (18 cases, 32.7%), lung (12 cases, 21.8%), liver (6 cases, 10.9%) and colorectum (6 cases, 10.9%), respectively. Thirty-four cases were confirmed by pathology after adrenalectomy and 21 cases were confirmed by needle biopsy. Thirty cases were diagnosed synchronously with the primary tumor and 25 cases were metachronous. The median time from diagnosis of primary tumors was 13.3 months (ranged 2.0 to 97.4 months). 42 cases of these 55 cases were diagnosed within one year. Treatment options for adrenal metastatic lesions included single adrenalectomy in 18 cases, adrenalectomy combined with radiotherapy 16 cases, single intravenous chemotherapy 10 cases, intravenous chemotherapy combined with non-operative treatment 10 cases and single radiotherapy 1 case.
ResultsThe main pathological types were adenocarcinoma (19 cases, 34.5%), ductal adenocarcinoma (10 cases, 18.2%), hepatocellular carcinoma (6 cases, 10.9%) and clear cell carcinoma (4 cases, 7.3%). Two cases were lost follow-up and the follow-up rate was 96%, the median follow-up time was 8 months (ranged 1 to 135 months). The median overall survival (OS) time of 55 patients was 5.3 months (ranged 1 to 134 months). The one-year survival rate was 23.6%(13/55), the two-year survival rate was 12.7%(7/55), the three-year survival rate was 9.1%(5/55) and the five-year survival rate was 1.8%(1/55).
ConclusionsPancreatic cancer was the most common type of malignant tumor for adrenal metastases in our hospital. Most primary tumors and adrenal metastases were diagnosed synchronously or within one year. Comprehensive treatment with retroperitoneal adrenalectomy may improve the OS, however the overall prognosis is poor.
Key words:
Adrenal gland; Malignant tumor; Metastasis; Treatment; Prognosis
Contributor Information
Juping Zhao
Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
Alimu Parehe·
Hongchao He
Fukang Sun
Wei He
Xin Huang
Jun Dai
Le Xu
Chen Fang
Danfeng Xu
