[Clinical evaluation for adrenal metastasis of renal cell carcinoma in a single institute].
OBJECTIVE
Clinicopathogical features and prognosis of patients with renal cell carcinoma (RCC) concomitant with adrenal involvement (metastasis or invasion) were evaluated in a single institute.


METHODS
In 380 patients with RCC who underwent radical nephrectomy 18 patients had adrenal involvement (13 ipsilateral adrenal involvement). Clinicopathological factors were compared between patients with ipsilateral adrnal involvement and control patients. Cause-spesific survival was calculated by Kaplan-Meier Method.


RESULTS
Patients with ipsilateral adrenal involvement had significantly higher percentage of tumor>5.5 cm, upper pole tumor, pathological stage (pT) 3< or =, lymph node metastasis, distant metastasis outside ipsilateral adrenal gland, histological grade 3 and microvascular invasion than control patients (p<0.05). Therefore, large tumor (especially 5.5 cm<), upper pole tumor, clinical T3 (especially patients with tumor thrombus), lymph node metastasis and distant metastasis were candidates for risk factors of ipsilateral adrenal involvement. 76.9% of ipsilateral adrenal metastasis could be diagnosed by computed tomography (CT). Thus, preoperative adrenal finding by CT is very important to determine the indication of ipsilateral adrenalectomy. All 3 patients with small ipsilateral adrenal metastasis that could not be detected preoperative CT died within one and half year postoperatively. Patients with solitary adrenal metastasis appeared to have better prognosis compared to those with both adrenal and other metastases. In 4 patients who survived more than 2 years after the presentation of adrenal metastasis, 3 patients had solitary adrenal metastasis and underwent adrenalectomy.


CONCLUSIONS
From the results in a single institute, radiological finding of adrenal grand, tumor size, tumor location, T stage, lymph node metastasis and distant metastasis outside ipsilateral adrenal gland are possible important factors to determine the indication of ipsilateral adrenalectomy preoperatively.
Department of Urology, National Defense Medical College.
Keiichi
K
Ito
Yasunori
Y
Mizuguchi
Akinori
A
Sato
Kenji
K
Kuroda
Akio
A
Horiguchi
Fumihiro
F
Kimura
Makoto
M
Sumitomo
Tomohiko
T
Asano
Masamichi
M
Hayakawa
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed