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      Therapeutics and Clinical Risk Management (submit here)

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      Adrenalectomy does not improve survival rates of patients with solitary adrenal metastasis from non-small cell lung cancer


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          Background and purpose

          Several case reports and studies have suggested that there is an increased survival rate for patients who undergo resection of solitary adrenal metastasis from non-small cell lung cancer (NSCLC). This study aimed to investigate whether NSCLC patients with solitary adrenal metastasis could gain a higher survival rate after adrenalectomy (ADX) when compared with those patients undergoing nonsurgical treatment, and to investigate the potential prognostic factors.

          Patients and methods

          A total of 1,302 NSCLC inpatients’ data from 2001 to 2015 were retrospectively reviewed to identify those with solitary adrenal metastasis. Overall survival for those who underwent both primary resection and ADX was compared to those patients with conservative treatment using the log-rank test. Potential prognostic variables were evaluated with univariate and multivariate analyses including clinical, therapeutic, pathologic, primary and metastatic data.


          A total of 22 NSCLC patients with solitary adrenal metastasis were identified, with an overall median survival of 11 months (95% confidence interval: 9.4–12.6 months) and a 1-year survival rate of 51.4% (95% confidence interval: 29.6%–73.2%). All of the patients had died by 30 months. There was no significant survival difference between patients who underwent primary and metastasis resection (n=10) and those treated conservatively (n=12), ( P=0.209). Univariate analysis identified Eastern Cooperative Oncology Group performance status (ECOG PS) as the significant predictor of survival ( P=0.024). Age (<65 vs ≥65 years), sex, pathologic type, mediastinal lymph node stage (N2 vs N0/N1), primary tumor size (<5 vs ≥5 cm), primary location (central vs peripheral), metastatic tumor size (<5 vs ≥5 cm), metastasis laterality, synchronous metastasis, and metastatic field radiotherapy were not identified as potential prognostic factors in relation to survival rate. In multivariate analysis, a stepwise selection procedure allowed both ECOG PS ( P=0.007, relative risk =3.57) and pathologic type ( P=0.069) to enter the Cox’s hazard function.


          Primary and metastatic radical resection may not prolong the survival of NSCLC patients with solitary adrenal metastasis. ECOG PS and pathologic type might be the prognostic factors for these patients.

          Most cited references13

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          Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: a systematic review and pooled analysis.

          Several small studies have reported that an adrenalectomy for isolated adrenal metastasis in non-small-cell lung cancer (NSCLC), along with a surgical resection for the primary lung cancer, can be curative. However, some suggest that the survival outcome among patients with a synchronous metastasis is poor. It remains unclear whether this treatment approach is warranted among those with synchronous metastasis. A search for publications on adrenalectomy for NSCLC was performed via the MEDLINE database. Studies reporting on survival outcomes and containing at least four analyzable patients who had surgery for primary lung cancer were included. Those not allowing separation of outcomes between synchronous and metachronous metastases were excluded. Synchronous metastasis was defined as a disease-free interval (DFI) of 6 months or less. There were 10 publications contributing 114 patients; 42% of patients had synchronous metastases and 58% had metachronous metastases. The median DFIs were 0 and 12 months, respectively. Patients in the synchronous group were younger than those in the metachronous group (median age 54 v 68 years). Complications from adrenalectomy were infrequent. Median overall survival was shorter for patients with synchronous metastasis than those with metachronous metastasis (12 months v 31 months, generalized Wilcoxon P value = .02). However, the 5-year survival estimates were equivalent at 26% and 25%, respectively. For an isolated adrenal metastasis from NSCLC, patients with a synchronous metastasis who underwent adrenalectomy had a shorter median overall survival than those with a metachronous metastasis. However, a durable long-term survival is achieved in approximately 25% in both groups.
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            Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors.

            Metastatic non-small cell lung carcinoma (NSCLC) generally carries a poor prognosis, and systemic therapy is the mainstay of treatment. However, extended survival has been reported in patients presenting with a limited number of metastases, termed oligometastatic disease. We retrospectively reviewed the outcomes of such patients treated at two centers.
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              Laparoscopic adrenalectomy for isolated adrenal metastasis.

              Use of laparoscopy for isolated adrenal metastases is controversial. The aims of this study were to characterize patients with isolated adrenal metastases; compare operative characteristics of the laparoscopic adrenalectomy (LA) versus open adrenalectomy (OA) approach; and compare long-term oncological and surgical outcomes. Our adrenal resection database (1995-2006) identified 63 OA and 31 LA cases done for isolated adrenal metastases. Subset analysis was performed for all patients from isolated lung metastases (n = 39) and for all tumors smaller than 4.5 cm (n = 49). Overall, local recurrence was 17%, median survival 30 months and 5-year estimated survival 31%. The only independent predictor of survival for all (n = 94) was adrenal tumor size less than 4.5 cm (P = 0.01). When comparing LA with OA, no differences in local recurrence, margin status, disease-free interval or overall survival were observed for the entire group, or for patients with metastases only from lung cancer (n = 39) or for those with tumors smaller than 4.5 cm (n = 49). LA provided significantly shorter operative time (175 vs 208 min, P = 0.04), lower estimated blood loss (EBL) (106 vs 749 cc, P < 0.0001), shorter length of hospital stay (2.8 vs 8.0 days, P < 0.0001) and fewer total complications (P < 0.0001). LA is equivalent to OA in terms of margin status, local recurrence, disease-free interval and overall survival. LA for metastatic adrenal lesions is safe, with equivalent long-term oncological outcomes providing the additional benefits of a minimally invasive technique. LA can be recommended as an appropriate initial approach for isolated adrenal metastases.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                23 March 2017
                : 13
                : 355-360
                [1 ]Department of Cardiothoracic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [2 ]Department of Emergency, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [3 ]Department of Nursing, Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [4 ]Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
                [5 ]Department of Pediatrics, Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University
                [6 ]Institution of Respiratory Disease of Sun Yat-sen University, Guangzhou, China
                Author notes
                Correspondence: Zhuang-Gui Chen, Department of Pediatrics, Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, China, Tel +86 020 8525 3380, Email chenzhuanggui@ 123456126.com

                These authors contributed equally to this work

                © 2017 Huang et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                adrenalectomy,solitary metastasis,non-small cell lung cancer,survival,prognostic factors
                adrenalectomy, solitary metastasis, non-small cell lung cancer, survival, prognostic factors


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