Adrenal gland as a target of synchronous and metacronous metastasis from renal cell carcinoma: results of surgical treatment in a single institution
Background. Surgical treatment of solitary and oligometastatic metastases in renal cell carcinoma (RCC) is one of the treatment options for modern oncology. The objective of study to compare surgical outcomes in treatment of synchronous and metachronous solitary metastatic adrenal tumors in RCC. Materials and methods. The study included 93 patients with kidney cancer, from 1997 till 2018, who underwent surgical treatment in the urological oncology department of the P.A. Hertzen Moscow Oncology Research Institute. The 1st group is represented by 58 patients with RCC and synchronous secondary adrenal gland lesion, who underwent simultaneous surgery, consist of radical nephrectomy and adrenalectomy without subsequent adjuvant therapy. The 2nd group included 35 patients with metachronous solitary metastatic adrenal gland lesion who underwent surgical treatment. Results. The progression of disease to left adrenal gland was observed in 40 (43.0 %) cases, to the right - in 39 (41.9 %), both adrenal glands - 14 (15.1 %) cases. The median diameter of the adrenal tumors was 44 (4-170) mm, the most common in both groups were tumors less than 5 cm (58.1 %). The sensitivity of ultrasound in the diagnosis of adrenal tumors was 80.6 %, computed tomography - 93.5 %, adrenal biopsy - 73.9 %. The median of the observation time was 42 months (1st group - 24 months, 2nd group - the median was not achieved). The one-year survival of patients with a metachronous lesion of adrenal was 82.3 +/- 76.6 % versus 52.8 +/- 7.1 % in the synchronous lesion group, three-year survival was 79.2 +/- 7.0 % versus 32.3 +/- 7.6 % and five-year - 57.0 +/- 10.0 % versus 16.2 +/- 12.0 %, respectively. In multivariate analysis, only a metachronous lesion is a factor of favorable prognosis (p = 0.002). Conclusion. Surgical treatment for metachronous adrenal gland metastatic lesions is appropriate intervention and provides better patient survival rates compared to synchronous lesions.