Romero Arenas Minerva Angelica, Sui Dawen, Grubbs Elizabeth G, Lee Jeffrey E, Perrier Nancy D
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Dr., Unit 1484, Houston, TX, 77030, USA,
World J Surg. 2014 Jun;38(6):1336-42. doi: 10.1007/s00268-014-2454-x.
The benefit of adrenalectomy (ADX) for adrenal metastasis is not established. We evaluated outcomes after ADX for patients with adrenal metastasis.
We retrospectively analyzed the records of 90 patients who underwent ADX for metastatic disease. Overall survival (OS) after ADX was calculated using the Kaplan-Meier method. Clinical factors were evaluated for associations with OS using a Cox regression model, and with operative factors using the Wilcoxon two-sample or Fisher's exact test.
The most common primary tumor types were melanoma (35, 39 %) and lung cancer (32, 35 %). A total of 49 (54 %) patients had isolated adrenal metastasis; 55 (61 %) underwent laparoscopic resection (LADX). Median OS was 2.46 years (range < 1 month-15 years), and 5-year survival rate was 38 % (6 % standard error). Most patients experienced disease progression (56, 62 %) despite achieving disease-free status following ADX (78, 86 %). When compared with the open approach, LADX was associated with smaller tumor size, as well as reduced blood loss, operative time, and length of stay (all p < 0.0001), and no difference in OS (p = 0.4122) or complications (p = 1). Isolated adrenal bed recurrence was similar in LADX (N = 3, 5 %) and open ADX (N = 2, 6 %) (p = 1), and did not affect OS (p = 0.2). Larger tumors were associated with shorter median OS (p = 0.0014).
ADX for metastasis can be safely performed in selected patients. Some patients with adrenal metastasis achieve prolonged survival following ADX. Compared with an open approach, LADX has no measurable oncologic disadvantage, minimizes morbidity, and should be considered when tumor characteristics permit.
肾上腺切除术（ADX）对肾上腺转移瘤的益处尚未明确。我们评估了肾上腺转移瘤患者接受ADX后的结局。
我们回顾性分析了90例因转移性疾病接受ADX的患者的记录。使用Kaplan-Meier方法计算ADX后的总生存期（OS）。使用Cox回归模型评估临床因素与OS的相关性，使用Wilcoxon两样本检验或Fisher精确检验评估与手术因素的相关性。
最常见的原发肿瘤类型为黑色素瘤（35例，39%）和肺癌（32例，35%）。共有49例（54%）患者为孤立性肾上腺转移；55例（61%）接受了腹腔镜切除术（LADX）。中位OS为2.46年（范围<1个月至15年），5年生存率为38%（标准误差6%）。尽管大多数患者在ADX后达到无病状态，但仍有56例（62%）出现疾病进展（78例，86%）。与开放手术相比，LADX与较小的肿瘤大小、较少的失血量、较短的手术时间和住院时间相关（所有p<0.0001），OS（p=0.4122）或并发症（p=1）无差异。LADX（N=3，5%）和开放ADX（N=2，6%）的孤立性肾上腺床复发相似（p=1），且不影响OS（p=0.2）。较大的肿瘤与较短的中位OS相关（p=0.0014）。
ADX可在选定患者中安全进行。一些肾上腺转移瘤患者在ADX后生存期延长。与开放手术相比，LADX没有可测量的肿瘤学劣势，可将发病率降至最低，在肿瘤特征允许时应予以考虑。
