Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
Eur Urol. 2011 Sep;60(3):458-64. doi: 10.1016/j.eururo.2011.04.022. Epub 2011 Apr 16.
The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied.
We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort.
DESIGN, SETTING, AND PARTICIPANTS: From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models.
Surgical removal of the adrenal gland at the time of kidney tumor resection.
Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases.
Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature.
Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.
在肾细胞癌（RCC）患者中，同侧肾上腺切除的适应证以及长期预后尚未得到很好的研究。
我们评估了在一个大型单机构队列中，RCC 患者同侧肾上腺受累的同步和异时性以及肾上腺切除术对复发和生存的影响。
设计、设置和参与者：1970 年至 2006 年，来自梅奥诊所的 4018 例接受手术切除（根治性肾切除术[RN]：3107 例；部分肾切除术[PN]：911 例）的 RCC 连续患者接受了同侧肾上腺受累的研究。使用多变量 Cox 模型比较了同侧肾上腺切除术（n = 1541）和未行肾上腺切除术（n = 2477）患者之间的异时性肾上腺转移和癌症特异性生存（CSS）的风险。
在肾肿瘤切除时切除肾上腺。
主要结果是癌症特异性生存；次要结果是同步和异时性肾上腺转移的发生率。
仍然存活的患者中位术后随访时间为 8.2 年（四分位距[IQR]：5.3-13.6）。同侧肾上腺同步受累罕见（n = 88；2.2%）。肾切除术时同侧肾上腺切除术并不能降低随后发生肾上腺转移的风险（风险比[HR]：0.96；95%置信区间[CI]，0.64-1.42）或改善 CSS（HR：1.08；95%CI，0.95-1.22）。初次手术后中位时间为 3.7 年（IQR：1.2-7.7）时，147 例（3.7%）患者发生了异步肾上腺转移。在初次手术未行肾上腺切除术的患者中，10 年内发生同侧与对侧异步肾上腺转移的风险相等。本研究的局限性在于其为单机构、非随机性质。
对于高危特征的患者，常规同侧肾上腺切除术似乎没有任何肿瘤学益处，而使相当一部分患者的孤立肾上腺处于转移风险中。因此，只有在有影像学或术中肾上腺受累证据的情况下，才应进行肾上腺切除术。
