Sandock D S, Seftel A D, Resnick M I
Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Urology. 1997 Jan;49(1):28-31. doi: 10.1016/S0090-4295(96)00388-3.
We undertook this study to establish criteria for adrenalectomy in patients with renal cell carcinoma.
We retrospectively reviewed the records of 162 patients undergoing radical nephrectomy from 1979 to 1993 at University Hospitals of Cleveland. Simultaneous ipsilateral adrenalectomy was performed in 57 patients (35%).
Three of these 57 patients (5.3%) had ipsilateral adrenal metastases. All 3 patients had large, left-sided, upper-pole tumors that extended through the renal capsule (Stage T3a). All 3 patients with adrenal metastases had progression to disseminated disease, with an average time to progression of 7.2 months, whereas only 13 (24%) of the 54 patients without adrenal metastases developed metastatic disease (none to adrenal), with an average time to progression of 27.6 months. No patient with organ-confined disease (Stage T1 or T2) or extracapsular disease in the midkidney or lower pole had adrenal metastases identified histologically.
The prognosis is poor for renal cell carcinoma with ipsilateral adrenal involvement, even with complete removal. Because of this poor prognosis, we believe that adrenal involvement should constitute a separate stage category. We propose that patients with ipsilateral adrenal metastases via direct extension should be classified as having pathologic Stage pT3d. If the patient has an ipsilateral adrenal metastasis not via direct extension, contralateral adrenal metastasis, or bilateral adrenal metastases, the pathologic stage should be M1. Ipsilateral adrenalectomy should only be performed if a lesion is seen preoperatively on computed tomographic scan or if gross disease is seen at the time of nephrectomy although its removal may not benefit the patient.
我们开展这项研究以确立肾细胞癌患者肾上腺切除术的标准。
我们回顾性分析了1979年至1993年在克利夫兰大学医院接受根治性肾切除术的162例患者的病历。其中57例患者（35%）同时进行了同侧肾上腺切除术。
这57例患者中有3例（5.3%）发生同侧肾上腺转移。所有3例患者均有大的左侧肾上极肿瘤，肿瘤穿过肾包膜（T3a期）。所有3例肾上腺转移患者均进展为播散性疾病，平均进展时间为7.2个月，而54例无肾上腺转移患者中只有13例（24%）发生转移性疾病（无肾上腺转移），平均进展时间为27.6个月。没有组织学证据表明局限于器官的疾病（T1或T2期）或肾中部或下极的肾包膜外疾病患者发生肾上腺转移。
肾细胞癌伴有同侧肾上腺受累时预后较差，即使肿瘤被完全切除。鉴于这种不良预后，我们认为肾上腺受累应构成一个单独的分期类别。我们建议，经直接蔓延发生同侧肾上腺转移的患者应分类为病理分期pT3d。如果患者发生非经直接蔓延的同侧肾上腺转移、对侧肾上腺转移或双侧肾上腺转移，病理分期应为M1。仅当术前计算机断层扫描发现病变或肾切除时发现肉眼可见的病变时才应进行同侧肾上腺切除术，尽管切除病变可能对患者无益。
