Metastases of renal cell carcinoma to the adrenal glands: results of surgical treatment
Vladimir Koloskov, Timur Britvin, Galina Polyakova, Mikhail Beloshitsky & Arian Kalinin
Renal cell carcinoma metastases to adrenal glands are indicative of a generalized tumor process, but in cases of solitary metastases, a radical surgical treatment of these patients is possible.
The object of the present study was an estimation of the remote outcome of surgical treatment of 18 patients with solitary renal cell carcinoma metastases to adrenal glands operated on in our clinic over the period from 1999 to 2008. Among them, there were 6 men and 12 women, aged 5277 year (mean age 65+5.7 years). In all cases, the renal cell carcinoma was verified during histologic investigation of the renal tumor. In 16 patients, adrenal metastases were unilateral, in 2 bilateral; in 8 patients synchronous, and in 10 metachronous. Metachronous metastases were revealed 9180 months later (mean 41.2 months) the radical nephrectomy. For topical diagnosis, US-scan, CT or MRI, and PET-scan were used. Adrenalectomy including tumor removal was an operation of choice (a total adrenalectomy was carried out in cases of bilateral adrenal metastases). A control group consisted of 8 patients who received only symptomatic treatment because of the multiple adrenal metastases from the renal cell carcinoma.
Follow up period after radical surgery of metastatic tumors was, on an average, 40.4+6.2 months (variation limits 4110 months); 11 patients are still alive, and 7 died of tumor progression (metastases to contralateral kidney, liver, and pancreas). The 1-, 3- and 5-year overall survival, calculated by the KaplanMeier method, was 71.4%, 64.9% and 43.2%, correspondingly. In the control group, the index of the 1- and 3-year overall survival formed 44.4% and 0%, accordingly (P<0.05). The median overall survival after adrenalectomy was 67.2 months that was reliably higher as compared with that of the control group (23.2 months, P<0.05). The 1-, 3- and 5-year disease-free survival was 70.1, 53.1 and 27.3%, conformably. The median disease-free survival after the radical adrenalectomy was 57.1 months.
The outcome obtained allows, in our view, to recommend adrenalectomy as a method of radical treatment of patients with renal cell carcinoma metastases to adrenal glands.