Factors influencing adrenal metastasis in renal cell carcinoma

Abstract

Objectives: We determine the incidence andcharacteristics of adrenal involvement inlocalized and advanced renal cell carcinoma,and evaluate the role of adrenalectomy as partof radical nephrectomy.Material and methods: From 1993 to 1999, 210patients with renal cell carcinoma (RCC), (139men and 71 women, mean age 60.8 years, range12–96) underwent radical nephrectomy withassociated adrenalectomy. Patients were dividedinto two subgroups of 106 with localized (stageT1-2 tumor, group1) and 104 with advanced(stage T3-4N01M01, group2) renal cellcarcinoma. A retrospective review ofpreoperative computerized tomography (CT) ofthe abdomen was performed. Radiographicfindings were subsequently compared topostoperative histopathological results toassess the predictive value of tumorcharacteristics and imaging in determiningadrenal metastasis.Results: Of the 210 patients, 15 (7.1%) hadadrenal involvement. Tumor stage correlatedwith probability of adrenal spread, with T3-4and T1-2 accounting for 13.4% and 0.9% ofcases, respectively (p < 0.001). Upper poleintrarenal RCC most likely to spread was localextension to the adrenal gland, representing53.3% of adrenal involvement. In contrast,multifocal, lower pole and mid region RCCtumors metastasized hematogenously,representing 21.4%, 7%, and 14% of adrenalmetastasis, respectively. The relationshipbetween intrarenal tumor size (mean 7.8 cm,range 4 to 21) and adrenal involvement was notstatistically significant. Preoperative CTdemonstrated 97.7% specificity, 98.4%negative predictive value, 87% sensitivity and80% positive value for adrenal involvement byRCC.Conclusions: Ipsilateral adrenalectomy shouldonly be performed if a lesion is seenpreoperatively on CT scan or if gross diseaseis seen at the time of nephrectomy.The prognosis is poor for RCC with ipsilateralinvolvement even with complete removal. Becauseof this poor prognosis we believe that adrenalinvolvement should constitute a separate stagecategory.