title: Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study.
abstract: BACKGROUND
  The survival benefits of adrenalectomy (ADx) in the setting of metastatic cancer and prognostic factors for recurrence-free (RFS) and overall survival (OS) after adrenalectomy for metastatic carcinoma are still under debate. We evaluated the impact of clinicopathological variables on RFS and OS after ADx for metastatic carcinoma in patients with primary cancer.
  
  
  METHODS
  A total of 32 patients undergoing ADx for metastatic cancer between 2004 and 2012 at two tertiary medical centers. Metastases were regarded as synchronous (<6 months) or metachronous (≥6 months) depending on the interval after primary surgery. Associations of perioperative clinicopathologic variables with RFS and OS were analyzed using Cox regression models.
  
  
  RESULTS
  In total, 32 patients received ADx for metastatic primary tumors located in the lung (n = 11), colon (n = 4), liver (n = 5), stomach (n = 3), kidney (n = 4), pancreas (n = 2), glottis, esophagus, cervix, and ovary (n = 1 each). The overall recurrence rate after adrenalectomy was 62.5% (n = 20). By univariate analysis, C-reactive protein, inflammation-based prognosis score, and adrenalectomy for curative intent were associated with RFS and OS. Independent prognostic factors for shorter RFS were operative method (laparoscopy HR 4.68, 95% CI 1.61-13.61, p = 0.005) and inflammation-based prognostic score (HR 11.8, 95% CI 2.50-55.7, p = 0.002). For shorter OS, synchronous metastasis (HR 3.05, 95% CI 1.07-11.94, p = 0.048) and inflammation-based prognostic score (HR 6.65, 95% CI 1.25-35.23, p = 0.026) were identified as independent prognostic factors.
  
  
  CONCLUSIONS
  Our pilot study suggests that synchronous disease and inflammation-based prognostic score are significant prognostic factors for survival and should be considered when performing ADx for metastatic diseases.
authors.forename: Eu Chang
authors.initials: EC
authors.lastname: Hwang
authors.forename: Insang
authors.initials: I
authors.lastname: Hwang
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Jung
authors.forename: Taek Won
authors.initials: TW
authors.lastname: Kang
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.forename: Suk Hee
authors.initials: SH
authors.lastname: Heo
authors.forename: Jun Eul
authors.initials: JE
authors.lastname: Hwang
authors.affiliation: Department of Urology, Korea University School of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea. kkangsung7@korea.ac.kr.
authors.forename: Sung Gu
authors.initials: SG
authors.lastname: Kang
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Jeong Gu
authors.initials: JG
authors.lastname: Lee
authors.forename: Je Jong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jun
authors.initials: J
authors.lastname: Cheon
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000401:mortality* / Q000601:surgery*; D000315:Adrenalectomy / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D010865:Pilot Projects; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome