Beitler A L, Urschel J D, Velagapudi S R, Takita H
Department of Thoracic Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA.
J Surg Oncol. 1998 Sep;69(1):54-7. doi: 10.1002/(sici)1096-9098(199809)69:1<54::aid-jso11>3.0.co;2-n.
Adrenal metastases from lung cancer usually indicate systemic disease and incurability. However, a small subset of patients with isolated adrenal metastases may achieve long-term survival with aggressive surgical resection of the adrenal gland. To clarify the role of adrenalectomy for metastatic lung cancer, we undertook a review of the published literature on this topic.
The English-language medical literature was searched for papers reporting surgical resection of adrenal metastases from lung cancer. Eleven articles were retrieved and their data pooled for analysis.
Sixty patients (including seven previously reported from our institution) formed the basis of this collective review. Thirty-two patients pooled from small series and case reports had a median survival of 24 months, and approximately one-third were 5-year survivors. Twenty-eight patients reported in two large series had a less favorable survival (approximately 14 months median survival).
Surgical resection of isolated adrenal metastases from lung cancer appears to have a modest survival advantage over nonoperative therapy, and it occasionally results in long-term survival. However, the relatively encouraging survival results reported in the literature could be related to careful patient selection for this aggressive therapy, publication bias in favor of positive treatment outcomes, or a combination of the two. Nevertheless, the results are encouraging enough to justify further investigation of this aggressive treatment strategy. Practical guidelines for management are proposed.
肺癌肾上腺转移通常提示存在全身性疾病且无法治愈。然而，一小部分孤立性肾上腺转移患者通过积极的肾上腺手术切除可能实现长期生存。为阐明肾上腺切除术在转移性肺癌中的作用，我们对该主题的已发表文献进行了综述。
检索英文医学文献中报道肺癌肾上腺转移手术切除的论文。检索到11篇文章，并汇总其数据进行分析。
60例患者（包括我们机构之前报道的7例）构成了本综合综述的基础。从小型系列研究和病例报告中汇总的32例患者的中位生存期为24个月，约三分之一为5年生存者。两个大型系列研究中报道的28例患者的生存情况较差（中位生存期约14个月）。
肺癌孤立性肾上腺转移的手术切除似乎比非手术治疗具有适度的生存优势，且偶尔可导致长期生存。然而，文献中报道的相对令人鼓舞的生存结果可能与对这种积极治疗的患者选择谨慎、有利于阳性治疗结果的发表偏倚或两者兼而有之有关。尽管如此，这些结果足以令人鼓舞，有理由对这种积极的治疗策略进行进一步研究。本文提出了实际的管理指南。
