title: Risk factors for ipsilateral adrenal involvement in renal cell carcinoma.
abstract: OBJECTIVE
  We retrospectively review patients treated for renal cell carcinoma at 19 institutes in collaboration with the Japanese Society of Renal Cancer, to clarify the risk factors for ipsilateral adrenal involvement (IADI).
  
  
  METHODS
  The clinicopathologic factors of the 30 patients with IADI were compared with those of the 926 control patients without IADI, and independent predictors for IADI were identified by multivariate analysis.
  
  
  RESULTS
  Preoperative computed tomography (CT) could detect 83.3% of the instances of synchronous ipsilateral adrenal metastasis. Patients with IADI had significantly larger primary tumors, higher pT stages and histologic grades, and higher percentages of upper pole involvement, microvascular invasion, spindle-cell-type tumors, lymph node metastasis (LNM), and distant metastasis (DM) outside the ipsilateral adrenal gland (IAd) than in control patients. Multivariate logistic regression analysis of clinical factors revealed that tumor size greater than 5.5 cm, pT stage of 3 or higher, LNM, and DM outside IAd, but not upper pole involvement, were significant predictors of IADI.
  
  
  CONCLUSIONS
  Tumor size greater than 5.5 cm, clinical T stage of 3 or higher (tumor for which pT stage of 3 or higher is suspected), LNM, and DM outside IAd seemed to be important preoperative indicators of IADI. These factors and CT findings would be useful preoperative indicators for ipsilateral adrenalectomy. Moreover, patients with renal cell carcinoma who have normal adrenal on CT, have a T1 tumor extending less than 5.5 cm, and have neither LNM nor DM are good candidates for adrenal-sparing nephrectomy.
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Japan. itok@ndmc.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Hayakazu
authors.initials: H
authors.lastname: Nakazawa
authors.forename: Ken
authors.initials: K
authors.lastname: Marumo
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Ozono
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Igarashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Momokuni
authors.initials: M
authors.lastname: Fukuda
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Tsushima
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayakawa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000556:secondary*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed