Tanvetyanon Tawee, Robinson Lary A, Schell Michael J, Strong Vivian E, Kapoor Rachna, Coit Daniel G, Bepler Gerold
Biostatistics Division, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 Magnolia Dr, Tampa, FL 33613, USA.
J Clin Oncol. 2008 Mar 1;26(7):1142-7. doi: 10.1200/JCO.2007.14.2091.
Several small studies have reported that an adrenalectomy for isolated adrenal metastasis in non-small-cell lung cancer (NSCLC), along with a surgical resection for the primary lung cancer, can be curative. However, some suggest that the survival outcome among patients with a synchronous metastasis is poor. It remains unclear whether this treatment approach is warranted among those with synchronous metastasis.
A search for publications on adrenalectomy for NSCLC was performed via the MEDLINE database. Studies reporting on survival outcomes and containing at least four analyzable patients who had surgery for primary lung cancer were included. Those not allowing separation of outcomes between synchronous and metachronous metastases were excluded. Synchronous metastasis was defined as a disease-free interval (DFI) of 6 months or less.
There were 10 publications contributing 114 patients; 42% of patients had synchronous metastases and 58% had metachronous metastases. The median DFIs were 0 and 12 months, respectively. Patients in the synchronous group were younger than those in the metachronous group (median age 54 v 68 years). Complications from adrenalectomy were infrequent. Median overall survival was shorter for patients with synchronous metastasis than those with metachronous metastasis (12 months v 31 months, generalized Wilcoxon P value = .02). However, the 5-year survival estimates were equivalent at 26% and 25%, respectively.
For an isolated adrenal metastasis from NSCLC, patients with a synchronous metastasis who underwent adrenalectomy had a shorter median overall survival than those with a metachronous metastasis. However, a durable long-term survival is achieved in approximately 25% in both groups.
多项小型研究报告称，对于非小细胞肺癌（NSCLC）的孤立性肾上腺转移灶进行肾上腺切除术，并对原发性肺癌进行手术切除，可能具有治愈性。然而，一些人认为同步转移患者的生存结果较差。对于同步转移患者是否采用这种治疗方法仍不明确。
通过MEDLINE数据库检索关于NSCLC肾上腺切除术的出版物。纳入报告生存结果且至少有4例接受原发性肺癌手术的可分析患者的研究。排除那些无法区分同步和异时转移结果的研究。同步转移定义为无病间期（DFI）为6个月或更短。
有10篇出版物共纳入114例患者；42%的患者有同步转移，58%的患者有异时转移。中位DFI分别为0个月和12个月。同步转移组的患者比异时转移组的患者年轻（中位年龄54岁对68岁）。肾上腺切除术的并发症很少见。同步转移患者的中位总生存期比异时转移患者短（12个月对31个月，广义Wilcoxon P值 = 0.02）。然而，5年生存率估计分别为26%和25%，两者相当。
对于NSCLC的孤立性肾上腺转移，接受肾上腺切除术的同步转移患者的中位总生存期比异时转移患者短。然而，两组中约25%的患者可实现持久的长期生存。
