Impact of primary histology on disease free survival after minimally invasive adrenalectomy for metastatic cancer
INTRODUCTION AND OBJECTIVES: The adrenal gland is a site of metastasis for several malignancies. Metastasectomy with the achievement of a no evidence of disease (NED) status demonstrated to positively impact the oncological outcome. We report oncological results of a single centre 10-year experience with minimally invasive adrenalectomy for isolated adrenal metastasis.
METHODS: From May 2004 to May 2014, 162 patients underwent laparoscopic or robotic adrenalectomy. Pathological examination showed a metastasis in 36 patients.
Baseline demographics, perioperative and follow up data were prospectively collected. Univariable and multivariable cox regression analyses were performed to identify predictors of disease free survival (DFS).
RESULTS: Median follow up was 28 months. Tumor histology was renal cell carcinoma (RCC) in 27 patients (75%). (Table 1) At univariable analysis bilateral adrenalectomy and primary tumor histology were predictors of DFS (p=0.048 and p=0.003, respectively).
At multivariable cox analysis the only independent predictor of DFS was primary tumor histology (p=0.008). Lung cancer displayed similar DFS compared to RCC (reference category), while colon cancer (p=0.021; HR 7.08 [95% CI 0.96-1.28]), bladder cancer (p=0.001; HR102.6 [95% CI 7.3-1440]) and melanoma (p=0.01; HR 26.3 [95% CI 2.17-319], were significantly associated with worse outcomes.
CONCLUSIONS: Oncologic outcomes after adrenalectomy for metastatic cancer mainly depends on the primary tumor histology.