title: Outcome and prognostic factors after adrenalectomy for patients with distant adrenal metastasis.
abstract: BACKGROUND
  The purpose of this study was to describe a single-institution experience with adrenal metastasectomy and to elucidate factors that may bear prognostic significance.
  
  
  METHODS
  This is a single-center, retrospective review of patients with adrenal metastasis who underwent adrenalectomy performed with curative intent between 2000 and 2012. The Kaplan-Meier method was used to evaluate overall survival from time of adrenalectomy to death or last follow-up. Primary endpoint was death from any cause. Clinical variables were examined for association with survival.
  
  
  RESULTS
  The study included 62 patients with mean age of 60 (±12) years; 55 % (34 of 62) were male, 85 % (53 of 62) presented with isolated adrenal metastasis, and 82 % (51 of 62) had metachronous disease with median disease-free interval (DFI) of 22 months (range, 6-217 months). Non-small cell lung cancer (NSCLC) was the most common primary comprising 50 % of cases. Median survival for the study population was 30 months (range, 1-145 months) and 5-year survival was 31 %. Patients with NSCLC had significantly shortened survival compared with non-NSCLC with median and 5-year survival of 17 versus 47 months and 27 % versus 38 %, respectively (p = .033). Synchronous metastasis (p = .028) and DFI < 12 months (p = .038) were also associated with worse survival outcome, though male gender (p = .69) and oligometastatic disease (p = .62) were not.
  
  
  CONCLUSIONS
  Adrenal metastasectomy resulted in median survival of 30 months and 5-year survival of 31 %. Shorter survival was associated with lung primary, short disease-free interval, and synchronous metastasis, but not with the presence of oligometastatic disease provided that the primary cancer and additional metastatic lesions were adequately controlled and amenable to resection.
authors.affiliation: Division of Endocrine Surgery and Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Howell
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.forename: Michaele J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McCoy
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D000315:Adrenalectomy / Q000401:mortality*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate