Adrenalectomy does not improve survival rates of patients with solitary adrenal metastasis from non-small cell lung cancer

Abstract

Background and purposeSeveral case reports and studies have suggested that there is an increased survival rate for patients who undergo resection of solitary adrenal metastasis from non-small cell lung cancer (NSCLC). This study aimed to investigate whether NSCLC patients with solitary adrenal metastasis could gain a higher survival rate after adrenalectomy (ADX) when compared with those patients undergoing nonsurgical treatment, and to investigate the potential prognostic factors.Patients and methodsA total of 1,302 NSCLC inpatients’ data from 2001 to 2015 were retrospectively reviewed to identify those with solitary adrenal metastasis. Overall survival for those who underwent both primary resection and ADX was compared to those patients with conservative treatment using the log-rank test. Potential prognostic variables were evaluated with univariate and multivariate analyses including clinical, therapeutic, pathologic, primary and metastatic data.ResultsA total of 22 NSCLC patients with solitary adrenal metastasis were identified, with an overall median survival of 11 months (95% confidence interval: 9.4–12.6 months) and a 1-year survival rate of 51.4% (95% confidence interval: 29.6%–73.2%). All of the patients had died by 30 months. There was no significant survival difference between patients who underwent primary and metastasis resection (n=10) and those treated conservatively (n=12), (P=0.209). Univariate analysis identified Eastern Cooperative Oncology Group performance status (ECOG PS) as the significant predictor of survival (P=0.024). Age (<65 vs ≥65 years), sex, pathologic type, mediastinal lymph node stage (N2 vs N0/N1), primary tumor size (<5 vs ≥5 cm), primary location (central vs peripheral), metastatic tumor size (<5 vs ≥5 cm), metastasis laterality, synchronous metastasis, and metastatic field radiotherapy were not identified as potential prognostic factors in relation to survival rate. In multivariate analysis, a stepwise selection procedure allowed both ECOG PS (P=0.007, relative risk =3.57) and pathologic type (P=0.069) to enter the Cox’s hazard function.ConclusionPrimary and metastatic radical resection may not prolong the survival of NSCLC patients with solitary adrenal metastasis. ECOG PS and pathologic type might be the prognostic factors for these patients.

Real-Time Tumor-Tracking Radiotherapy and General Stereotactic Body Radiotherapy for Adrenal Metastasis in Patients With Oligometastasis

“… 21 Metastatic adrenal tumors can be large and can cause uncomfortable symptoms; when the tumor is small enough, it is reasonable to use these technologies to reduce the dose to the surrounding critical organs. It has been reported that surgical resection does not prolong OS, even for patients with oligometastatic non-small cell lung cancer 27 ; these patients should therefore be informed about RTRT or g-SBRT as an alternative treatment.…”

Current surgical management of extrapulmonary oligometastatic non-small cell lung carcinoma

“…The median survival was 11 months and 1-year survival rate was 51.4% for all 22 patients [43]. There was no significant survival difference between patients who underwent primary and metastasis resection and those treated conservatively [43]. Moreno et al reported adrenal metastasectomy for oligometastatic NSCLC had lower survive rates when compared to the metastasectomy applied to other tumors, especially for renal cell carcinoma [44].…”

“…Although the contribution of adrenalectomy to survive was demonstrated in various studies, there are some studies claiming this process does not have any contribution to survive in oligometastatic NSCLC cases. According to Huang et al adrenalectomy does not improve survival rates of patients with solitary adrenal metastasis in NSCLC [43]. Huang et al identified 22 NSCLC patients with solitary adrenal metastasis; 10 of these patients had adrenalectomy, and 12 were treated by non-surgically [43].…”

“…According to Huang et al adrenalectomy does not improve survival rates of patients with solitary adrenal metastasis in NSCLC [43]. Huang et al identified 22 NSCLC patients with solitary adrenal metastasis; 10 of these patients had adrenalectomy, and 12 were treated by non-surgically [43]. The median survival was 11 months and 1-year survival rate was 51.4% for all 22 patients [43].…”

“…Huang et al identified 22 NSCLC patients with solitary adrenal metastasis; 10 of these patients had adrenalectomy, and 12 were treated by non-surgically [43]. The median survival was 11 months and 1-year survival rate was 51.4% for all 22 patients [43]. There was no significant survival difference between patients who underwent primary and metastasis resection and those treated conservatively [43].…”