Mourra Najat, Hoeffel Christine, Duvillard Pierre, Guettier Catherine, Flejou Jean-François, Tiret Emmanuel
Department of Pathology, Hôpital St-Antoine, Paris, France.
Dis Colon Rectum. 2008 Dec;51(12):1846-9. doi: 10.1007/s10350-008-9235-2. Epub 2008 Mar 4.
Metastasis to the adrenal glands is a relatively frequent finding at autopsy. Adrenal metastasis of colorectal carcinoma is rare (14 percent). Isolated adrenal metastasis is even rarer, and presents a therapeutic dilemma.
Between 1997 and 2006, eight patients (5 men; mean age, 62 years) underwent adrenalectomy for metastasis of colorectal carcinoma. The tumors were Stage D in four cases, Stage B in two cases, and Stage C in the remaining two. Adjuvant chemotherapy was instituted.
All patients were asymptomatic, and adrenal metastasis was suspected from an elevated serum level of carcinoembryogenic antigen or discovered by computed tomography. Adrenal metastases were metachronous in seven patients, with median disease-free interval of 3.75 years. At the time of follow-up, one patient remained alive and free of disease 12 months after adrenalectomy, one patient was lost to follow-up after 22 months, and 6 patients have died from malignancy. The mean survival for the patients who died was 32 months.
The rarity of isolated adrenal metastasis of colorectal carcinoma makes a randomized, prospective trial comparing surgery vs. nonsurgical management highly unlikely. Our results provide further support for surgical resection of solitary adrenal metastasis, which may translate into survival benefit.
肾上腺转移在尸检中是相对常见的发现。结直肠癌的肾上腺转移罕见（14%）。孤立性肾上腺转移更为罕见，并且带来了治疗难题。
1997年至2006年间，8例患者（5例男性；平均年龄62岁）因结直肠癌转移接受了肾上腺切除术。4例肿瘤为D期，2例为B期，其余2例为C期。进行了辅助化疗。
所有患者均无症状，肾上腺转移通过血清癌胚抗原水平升高怀疑或通过计算机断层扫描发现。7例患者的肾上腺转移为异时性，无病间隔中位数为3.75年。随访时，1例患者在肾上腺切除术后12个月仍存活且无疾病，1例患者在22个月后失访，6例患者死于恶性肿瘤。死亡患者的平均生存期为32个月。
结直肠癌孤立性肾上腺转移的罕见性使得进行一项比较手术与非手术治疗的随机、前瞻性试验极不可能。我们的结果为孤立性肾上腺转移的手术切除提供了进一步支持，这可能转化为生存获益。
