Li G R, Soulie M, Escourrou G, Plante P, Pontonnier F
Department of Urology and Pathology, Hospital of Rangueil, CHU Toulouse, France.
Br J Urol. 1996 Dec;78(6):826-8. doi: 10.1046/j.1464-410x.1996.02633.x.
To examine adrenal invasion by renal cell carcinoma (RCC), particularly by adrenal micrometastasis, to determine whether adrenalectomy should be performed during radical nephrectomy.
From 1987 to 1994, 129 patients with RCC (90 men and 39 women, mean age 61.4 years, range 22-81) underwent radical nephrectomy with associated adrenalectomy because they had risk factors for adrenal invasion (tumour size > 5 cm. or tumour of the superior pole). Pathological examinations were carried out systematically and records of these examinations reviewed. The tumour size was recorded and the frequency of invasion calculated.
There were 10 cases where the gland was invaded: one was a synchronous contralateral metastasis and nine (7%) were ipsilateral invasions of which two were tumours in the superior pole that invaded the gland by direct extension and the other seven invaded the gland by distant metastasis, six being micrometastatic (4.7%). A single micrometastasis was found in two cases (1.5%). There was no adrenal invasion by tumours of < 5 cm in diameter from the superior pole. When only tumours > 5 cm in diameter were considered, the ipsilateral invasion rate was 11% (9/80) and the micrometastatic rate was 7.5% (6/80).
Adrenalectomy need not be performed routinely in small tumours which are detected early, but the possibility of adrenal micrometastasis from larger tumours (> 5 cm) should be considered.
研究肾细胞癌（RCC）对肾上腺的侵犯情况，尤其是肾上腺微转移情况，以确定在根治性肾切除术中是否应行肾上腺切除术。
1987年至1994年，129例肾细胞癌患者（90例男性，39例女性，平均年龄61.4岁，范围22 - 81岁）因存在肾上腺侵犯的危险因素（肿瘤大小>5 cm或上极肿瘤）接受了根治性肾切除术及同期肾上腺切除术。对病理检查进行了系统分析，并回顾了这些检查记录。记录肿瘤大小并计算侵犯频率。
有10例肾上腺受侵犯：1例为同步对侧转移，9例（7%）为同侧侵犯，其中2例为上极肿瘤直接侵犯肾上腺，另外7例通过远处转移侵犯肾上腺，6例为微转移（4.7%）。2例（1.5%）发现单个微转移灶。直径<5 cm的上极肿瘤未侵犯肾上腺。仅考虑直径>5 cm的肿瘤时，同侧侵犯率为11%（9/80），微转移率为7.5%（6/80）。
对于早期发现的小肿瘤，不必常规进行肾上腺切除术，但应考虑较大肿瘤（>5 cm）发生肾上腺微转移的可能性。
