Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Urology
Published in: BMC Urology 1/2014

Open Access 01-12-2014 | Research article

Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study

Authors: Eu Chang Hwang, Insang Hwang, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Suk Hee Heo, Jun Eul Hwang, Sung Gu Kang, Seok Ho Kang, Jeong Gu Lee, Je Jong Kim, Jun Cheon

Published in: BMC Urology | Issue 1/2014

Login to get access

Abstract

Background

The survival benefits of adrenalectomy (ADx) in the setting of metastatic cancer and prognostic factors for recurrence-free (RFS) and overall survival (OS) after adrenalectomy for metastatic carcinoma are still under debate. We evaluated the impact of clinicopathological variables on RFS and OS after ADx for metastatic carcinoma in patients with primary cancer.

Methods

A total of 32 patients undergoing ADx for metastatic cancer between 2004 and 2012 at two tertiary medical centers. Metastases were regarded as synchronous (<6 months) or metachronous (≥6 months) depending on the interval after primary surgery. Associations of perioperative clinicopathologic variables with RFS and OS were analyzed using Cox regression models.

Results

In total, 32 patients received ADx for metastatic primary tumors located in the lung (n = 11), colon (n = 4), liver (n = 5), stomach (n = 3), kidney (n = 4), pancreas (n = 2), glottis, esophagus, cervix, and ovary (n = 1 each). The overall recurrence rate after adrenalectomy was 62.5% (n = 20). By univariate analysis, C-reactive protein, inflammation-based prognosis score, and adrenalectomy for curative intent were associated with RFS and OS. Independent prognostic factors for shorter RFS were operative method (laparoscopy HR 4.68, 95% CI 1.61-13.61, p = 0.005) and inflammation-based prognostic score (HR 11.8, 95% CI 2.50-55.7, p = 0.002). For shorter OS, synchronous metastasis (HR 3.05, 95% CI 1.07-11.94, p = 0.048) and inflammation-based prognostic score (HR 6.65, 95% CI 1.25-35.23, p = 0.026) were identified as independent prognostic factors.

Conclusions

Our pilot study suggests that synchronous disease and inflammation-based prognostic score are significant prognostic factors for survival and should be considered when performing ADx for metastatic diseases.
Literature
1.
Bullock WK, Hirst AE: Metastatic carcinoma of the adrenal. Am J Med Sci. 1953, 226: 521-524. 10.1097/00000441-195322650-00007.CrossRefPubMed
2.
Lenert JT, Barnett CC, Kudelka AP, Sellin RV, Gagel RF, Prieto VG, Skibber JM, Ross MI, Pisters PW, Curley SA, Evans DB, Lee JE: Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery. 2001, 130: 1060-1067. 10.1067/msy.2001.118369.CrossRefPubMed
3.
Lee JE, Evans DB, Hickey RC, Sherman SI, Gagel RF, Abbruzzese MC, Abbruzzese JL: Unknown primary cancer presenting as an adrenal mass: frequency and implications for diagnostic evaluation of adrenal incidentalomas. Surgery. 1998, 124: 1115-1122. 10.1067/msy.1998.92009.CrossRefPubMed
4.
Kim SH, Brennan MF, Russo P, Burt ME, Coit DG: The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer. 1998, 82: 389-394. 10.1002/(SICI)1097-0142(19980115)82:2<395::AID-CNCR20>3.0.CO;2-T.CrossRefPubMed
5.
Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, Marrero AM, Prasad M, Blumgart LH, Brennan MF: Liver resection for colorectal metastases. J Clin Oncol. 1997, 15: 938-946.PubMed
6.
1997: Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. The International Registry of Lung Metastases. J Thorac Cardiovasc Surg. 1997, 113: 37-49. 10.1016/S0022-5223(97)70397-0.CrossRef
7.
Collinson FJ, Lam TK, Bruijn WM, de Wilt JH, Lamont M, Thompson JF, Kefford RF: Long-term survival and occasional regression of distant melanoma metastases after adrenal metastasectomy. Ann Surg Oncol. 2008, 15: 1741-1749. 10.1245/s10434-008-9836-y.CrossRefPubMed
8.
Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, Bepler G: Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008, 26: 1142-1147. 10.1200/JCO.2007.14.2091.CrossRefPubMed
9.
Muth A, Persson F, Jansson S, Johanson V, Ahlman H, Wängberg B: Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol. 2010, 36: 699-704. 10.1016/j.ejso.2010.04.002.CrossRefPubMed
10.
Vazquez BJ, Richards ML, Lohse CM, Thompson GB, Farley DR, Grant CS, Huebner M, Moreno J: Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg. 2012, 36: 1400-1405. 10.1007/s00268-012-1506-3.CrossRefPubMed
11.
Ma X, Li H, Zhang X, Huang Q, Wang B, Shi T, Hu D, Ai Q, Liu S, Gao J, Yang Y, Dong J, Zheng T: Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis. Surg Endosc. 2013, 27: 992-999. 10.1007/s00464-012-2553-4.CrossRefPubMed
12.
Lo CY, van Heerden JA, Soreide JA, Grant CS, Thompson GB, Lloyd RV, Harmsen WS: Adrenalectomy for metastatic disease to the adrenal glands. Br J Surg. 1996, 83: 528-531. 10.1002/bjs.1800830432.CrossRefPubMed
13.
Lam KY, Lo CY: Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol (Oxf). 2002, 56: 95-101. 10.1046/j.0300-0664.2001.01435.x.CrossRef
14.
Abrams HL, Spiro R, Goldstein N: Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950, 3: 74-85. 10.1002/1097-0142(1950)3:1<74::AID-CNCR2820030111>3.0.CO;2-7.CrossRefPubMed
15.
Kuczyk M, Wegener G, Jonas U: The therapeutic value of adrenalectomy in case of solitary metastatic spread originating from primary renal cell cancer. Eur Urol. 2005, 48: 252-257. 10.1016/j.eururo.2005.04.004.CrossRefPubMed
16.
Howell GM, Carty SE, Armstrong MJ, Stang MT, McCoy KL, Bartlett DL, Yip L: Outcome and prognostic factors after adrenalectomy for patients with distant adrenal metastasis. Ann Surg Oncol. 2013, 20: 3491-3496. 10.1245/s10434-013-3050-2.CrossRefPubMedPubMedCentral
17.
Elashry OM, Clayman RV, Soble JJ, McDougall EM: Laparoscopic adrenalectomy for solitary metachronous contralateral adrenal metastasis from renal cell carcinoma. J Urol. 1997, 157: 1217-1222. 10.1016/S0022-5347(01)64927-9.CrossRefPubMed
18.
Bonnet S, Gaujoux S, Leconte M, Thillois JM, Tissier F, Dousset B: Laparoscopic adrenalectomy for metachronous metastasis from renal cell carcinoma. World J Surg. 2008, 32: 1809-1814. 10.1007/s00268-008-9539-3.CrossRefPubMed
19.
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ: Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004, 90: 1704-1706.PubMedPubMedCentral
20.
McMillan DC, Crozier JE, Canna K, Angerson WJ, McArdle CS: Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007, 22: 881-886. 10.1007/s00384-006-0259-6.CrossRefPubMed
21.
Leitch EF, Chakrabarti M, Crozier JE, McKee RF, Anderson JH, Horgan PG, McMillan DC: Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007, 97: 1266-1270. 10.1038/sj.bjc.6604027.CrossRefPubMedPubMedCentral
22.
Brown DJ, Milroy R, Preston T, McMillan DC: The relationship between an inflammation-based prognostic score (Glasgow Prognostic Score) and changes in serum biochemical variables in patients with advanced lung and gastrointestinal cancer. J Clin Pathol. 2007, 60: 705-708. 10.1136/jcp.2005.033217.CrossRefPubMed
23.
Ishizuka M, Nagata H, Takagi K, Horie T, Kubota K: Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg. 2007, 246: 1047-1051. 10.1097/SLA.0b013e3181454171.CrossRefPubMed
24.
Read JA, Choy ST, Beale PJ, Clarke SJ: Evaluation of nutritional and inflammatory status of advanced colorectal cancer patients and its correlation with survival. Nutr Cancer. 2006, 55: 78-85. 10.1207/s15327914nc5501_10.CrossRefPubMed
25.
McMillan DC: An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008, 67: 257-262. 10.1017/S0029665108007131.CrossRefPubMed
26.
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ: Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003, 89: 1028-1030. 10.1038/sj.bjc.6601242.CrossRefPubMedPubMedCentral
27.
Roxburgh CS, McMillan DC: Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010, 6: 149-163. 10.2217/fon.09.136.CrossRefPubMed
28.
Fearon KC, Voss AC, Hustead DS, Cancer Cachexia Study Group: Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006, 83: 1345-1350.PubMed
29.
McMillan DC: Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009, 12: 223-226. 10.1097/MCO.0b013e32832a7902.CrossRefPubMed
30.
Lamb GW, Aitchison M, Ramsey S, Housley SL, McMillan DC: Clinical utility of the Glasgow Prognostic Score in patients undergoing curative nephrectomy for renal clear cell cancer: basis of new prognostic scoring systems. Br J Cancer. 2012, 106: 279-283. 10.1038/bjc.2011.556.CrossRefPubMed
Metadata
Title
Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study
Authors
Eu Chang Hwang
Insang Hwang
Seung Il Jung
Taek Won Kang
Dong Deuk Kwon
Suk Hee Heo
Jun Eul Hwang
Sung Gu Kang
Seok Ho Kang
Jeong Gu Lee
Je Jong Kim
Jun Cheon
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2014
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/1471-2490-14-41

Other articles of this Issue 1/2014

BMC Urology 1/2014 Go to the issue

Research article

microRNA-99a acts as a tumor suppressor and is down-regulated in bladder cancer

Research article

Preoperative lymphocyte-to-monocyte ratio predicts clinical outcome in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder: a retrospective analysis

Technical advance

Development of an in vitro model to measure bioactivity of botulinum neurotoxin A in rat bladder muscle strips

Research article

A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics

Research article

Impact of prostate weight on perioperative outcomes of robot-assisted laparoscopic prostatectomy with a posterior approach to the seminal vesicle

Research article

Disease-specific outcomes of Radical Prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time