Ferriero Mariaconsiglia, Iannuzzi Andrea, Bove Alfredo Maria, Tuderti Gabriele, Anceschi Umberto, Misuraca Leonardo, Brassetti Aldo, Mastroianni Riccardo, Guaglianone Salvatore, Leonardo Costantino, Papalia Rocco, Gallucci Michele, Simone Giuseppe
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy.
Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
Cancers (Basel). 2024 Feb 13;16(4):763. doi: 10.3390/cancers16040763.
Adrenalectomy is commonly considered a curative treatment in case of adrenal gland as site of metastasis. In the present study, we evaluated the impact of primary tumor histology on survival outcomes after a minimally invasive adrenal mastectomy for a solitary metachronous metastasis. From May 2004 to August 2020, we prospectively collected data on minimally invasive adrenalectomies whose pathological examination showed a metastasis. All patients only received metastasectomies that were performed with curative intent, or to achieve non-evidence of disease status. Adjuvant systemic therapy was not administered in any case. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were applied to identify independent predictors of CSS. Out of 235 laparoscopic and robotic adrenalectomies, the pathologic report showed metastases in 60 cases. The primary histologies included 36 (60%) renal cell carcinoma (RCC), 9 (15%) lung cancer, 6 (10%) colon cancer, 4 (6.7%) sarcoma, 3 (5%) melanoma and 2 (3.3%) bladder cancer. RCC displayed significantly longer survival rates with a 5-year CSS of 55.9%, versus 22.8% for other histologies (log-rank = 0.01). At univariable analysis, disease-free interval (defined as the time from adrenalectomy to evidence of disease progression) < 12 months and histology were predictors of CSS ( = 0.003 and < 0.001, respectively). At multivariable Cox analysis, the only independent predictor of CSS was primary tumor histology ( = 0.005); patients with adrenal metastasis from colon cancer and bladder cancer showed a 5.3- and 75.5-fold increased risk of cancer death, respectively, compared to patients who had RCC as primary tumor histology. Oncological outcomes of adrenal metastasectomies are strongly influenced by primary tumor histology. A proper discussion of the role of surgery in a multidisciplinary context could provide optimal treatment strategies.
对于肾上腺作为转移灶的情况，肾上腺切除术通常被视为一种根治性治疗方法。在本研究中，我们评估了原发性肿瘤组织学对单发异时性转移灶行微创肾上腺切除术后生存结局的影响。2004年5月至2020年8月，我们前瞻性收集了病理检查显示为转移灶的微创肾上腺切除术的数据。所有患者仅接受了以根治为目的或实现疾病无证据状态的转移灶切除术。在任何情况下均未给予辅助全身治疗。采用Kaplan-Meier法评估癌症特异性生存（CSS）。应用单变量和多变量Cox回归分析来确定CSS的独立预测因素。在235例腹腔镜和机器人肾上腺切除术中，病理报告显示60例有转移灶。原发性组织学类型包括36例（60%）肾细胞癌（RCC）、9例（15%）肺癌、6例（10%）结肠癌、4例（6.7%）肉瘤、3例（5%）黑色素瘤和2例（3.3%）膀胱癌。RCC的生存率显著更长，5年CSS为55.9%，而其他组织学类型为22.8%（对数秩检验 = 0.01）。在单变量分析中，无病间期（定义为从肾上腺切除术到疾病进展证据出现的时间）<12个月和组织学类型是CSS的预测因素（分别为 = 0.003和 < 0.001）。在多变量Cox分析中，CSS的唯一独立预测因素是原发性肿瘤组织学类型（ = 0.005）；与以RCC作为原发性肿瘤组织学类型的患者相比，结肠癌和膀胱癌肾上腺转移患者的癌症死亡风险分别增加了5.3倍和75.5倍。肾上腺转移灶切除术的肿瘤学结局受原发性肿瘤组织学类型的强烈影响。在多学科背景下对手术作用进行恰当讨论可为提供最佳治疗策略。
