Elsevier

The Annals of Thoracic Surgery

Volume 92, Issue 5, November 2011, Pages 1788-1793
The Annals of Thoracic Surgery

Original article
General thoracic
Outcomes of Patients With Isolated Adrenal Metastasis From Non-Small Cell Lung Carcinoma

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.05.116Get rights and content

Background

Long-term survival of patients who undergo surgical resection of isolated adrenal metastasis from non-small cell lung cancer (NSCLC) has been reported. The aim of this study was to compare survival of patients who underwent adrenalectomy with those treated nonoperatively, and to analyze clinical characteristics associated with long-term survival.

Methods

Between January 1994 and July 2010, 37 patients with isolated adrenal metastasis from NSCLC were identified. Twenty patients underwent adrenalectomy. Patients did not undergo adrenalectomy owing to suspicion of N2 disease, medical comorbidities, or patient preference. Seven patients (35%) treated surgically had tumors that were ipsilateral to their primary tumor, and 8 (40%) had metachronous metastases.

Results

Five-year overall survival was 34% for patients treated operatively and 0% for patients treated nonoperatively p = 0.002). Among patients treated with adrenalectomy, patients with ipsilateral metastases had a 5-year survival of 83% compared with 0% for patients with contralateral metastases (p = 0.003). Patients without mediastinal nodal disease had a 5-year survival of 52% compared with 0% for patients with mediastinal nodal disease (p = 0.008). Survival of patients who underwent adrenalectomy for synchronous and metachronous adrenal metastases was not significantly different (p = 0.81).

Conclusions

Surgical resection of isolated adrenal metastasis from lung cancer provides a survival benefit in well-selected patients compared with nonoperative management. No patient with contralateral adrenal metastases or mediastinal nodal disease survived long term after adrenalectomy. The time interval between treatment of the primary lung cancer and adrenal metastasis was not significantly associated with survival, but the cohort size was small.

Section snippets

Material and Methods

We searched the pathology database at the Massachusetts General Hospital for reports on adrenal specimens that contained mention of lung cancer in the report text between January 1994 and July 2010. This included both cytology (fine needle aspiration or core needle biopsy) and surgical pathology (adrenalectomy) specimens. All patients who underwent adrenalectomy for metastatic lung cancer were included, and all underwent lung resection and complete adrenalectomy. Patients underwent either open

Results

During the study period, 20 patients underwent adrenalectomy and 17 patients with isolated adrenal metastasis were treated nonoperatively. There were no operative deaths. Patients did not undergo adrenalectomy owing to presence of ipsilateral mediastinal nodal disease in 7 patients, because of extensive comorbid conditions in 3 patients, and because of patient preference in 1 patient. Adrenalectomy was not offered for unclear reasons in 6 patients. Relevant clinical characteristics are

Comment

This study corroborates the findings of other published series that resection of adrenal metastases is associated with long-term survival in a subset of patients with lung cancer [1, 2, 3, 4, 5, 6, 7]. The 5-year overall survival was 34% among patients who underwent adrenalectomy, comparable to the 5-year survival of 25% reported by Tanventayon and colleagues [8] in their systematic review of adrenalectomy for lung cancer metastasis. There were no long-term survivors among patients with

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