Adrenalectomy for Secondary Malignancy: Patients, Outcomes, and Indications.

ABSTRACT

OBJECTIVE: The goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy. BACKGROUND: Adrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined. METHODS: A retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards. RESULTS: Of 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS 54%, 5-year DFS 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR) 0.49, P = 0.008). Extra-adrenal oligometastatic disease at initial presentation (HR 1.84, P = 0.016), larger tumor size (HR 1.07, P = 0.013), chemotherapy as treatment of the primary tumor (HR 2.07 P = 0.027) and adjuvant chemotherapy (HR 1.95, P = 0.009) were associated with shorter DFS. Median OS was 53 months (1-year OS 83%, 5-year OS 43%). On multivariable analysis, extra-adrenal oligometastatic disease at adrenalectomy (HR 1.74, P = 0.031), and incomplete resection of adrenal metastasis (R1 margins; HR 1.62, P = 0.034; R2 margins; HR 5.45, P = 0.002) were associated with shorter OS. CONCLUSIONS: Durable survival is observed in patients undergoing adrenal metastasectomy and should be considered for subjects with isolated adrenal metastases.