[Is surgery required for patients with isolated adrenal metastasis of non-small cell lung carcinoma?].
BACKGROUND
No consensus yet governs management of solitary adrenal metastasis of non-small cell lung cancer (NSCLC). Although classically considered incurable, various case reports and small series indicate that surgical treatment may improve long-term survival. The aim of this study was to review our experience and to identify factors that may affect survival.


METHODS
From January 1989 through June 2006, 26 patients (21 men and 5 women; mean age: 54+/-10 years) underwent complete resection of an isolated adrenal metastasis after surgical treatment of NSCLC. The adrenal metastasis was diagnosed at the same time as the NSCLC in 6 patients and subsequently in 20 patients. Median disease-free interval for patients with metachronous metastasis was 13.8 months (range: 4.5 to 60.1 months).


RESULTS
The overall 5- and 10-year survival rates were 31 and 21% respectively. Univariate and multivariate analysis showed that a disease-free interval longer than 6 months was a significant independent predictor of longer survival in patients after adrenalectomy. All patients with a disease-free interval of less than 6 months died within 2 years of surgery. After resection of an isolated adrenal metastasis diagnosed more than 6 months after lung resection, the 5-year survival rate was 49%. Adjuvant therapy and pathological staging of NSCLC did not affect survival.


CONCLUSIONS
Surgical resection of subsequent isolated adrenal metastasis with a disease-free interval longer than 6 months can lead to long-term survival in patients with previous complete resection of the primary NSCLC.
Mercier
Olaf
O
Service de chirurgie thoracique et vasculaire et de transplantation cardiopulmonaire, Hôpital Marie Lannelongue, Le Plessis Robinson. olaf.mercier@gmail.com
Fadel
Elie
E
Mussot
Sacha
S
Fabre
Dominique
D
Chataigner
Olivier
O
Chapelier
Alain
A
Dartevelle
Philippe
P
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003627:Data Interpretation, Statistical; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011860:Radiography, Abdominal; D013997:Time Factors; D014057:Tomography, X-Ray Computed