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.

1. Ferlay J.E.M., Lam F., Colombet M. et al. Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer. 2018. Available by: https://gco.iarc.fr/today/home.

2. State of oncological care in Russia in 2018. Eds.: А.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS radiologii” Minzdrava Rossii, 2019. 236 p. (In Russ.).

3. Ioachimescu A.G., Remer E.M., Hamrahian A.H. Adrenal incidentalomas: a disease of modern technology offering opportunities for improved patient care. Endocrinol Metab Clin North Am 2015;44(2):335–54. DOI: 10.1016/j.ecl.2015.02.005.

4. Kloos R.T., Gross M.D., Francis I.R. et al. Incidentally discovered adrenal masses. Endocr Rev 1995;16(4):460–84. DOI: 10.1210/edrv-16-4-460.

5. Gong J., Maia M.C., Dizman N. et al. Metastasis in renal cell carcinoma: biology and implications for therapy. Asian J Urol 2016;3(4):286–92. DOI: 10.1016/j.ajur.2016.08.006.

6. Ljungberg B., Albiges L., Abu-Ghanem Y. et al. European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 2019;75(5):799– 810. DOI: 10.1016/j.eururo.2019.02.011.

7. Han J.H., Lee S.H., Ham W.S. et al. Inherent characteristics of metachronous metastatic renal cell carcinoma in the era of targeted agents. Oncotarget 2017;8(45):78825–37. DOI: 10.18632/oncotarget.20230.

8. Russo A.E., Untch B.R., Kris M.G. et al. Adrenal metastasectomy in the presence and absence of extraadrenal metastatic disease. Ann Surg 2019;270(2):373–7. DOI: 10.1097/SLA.0000000000002749.

9. Moreno P., de la Quintana Basarrate A., Musholt T.J. et al. Adrenalectomy for solid tumor metastases: results of a multicenter European study. Surgery 2013;154(6):1215–22. DOI: 10.1016/j.surg.2013.06.021.

10. Ramacciato G., Mercantini P., La Torre M. et al. Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surgical Endoscopy 2008;22(2):516–21. DOI: 10.1007/s00464-007-9508-1.

11. Borisov P.S., Orlova R.V., Shkolnik M.I., Karlov P.A. Evaluation of the efficiency of combination palliative treatment in patients with metastatic clear-cell renal cell carcinoma. Onkourologiya = Cancer Urology 2015;11(3):55–61. (In Russ.). DOI: 10.17650/1726-9776-2015-11-3-55-61.

12. Latypov V.R., Popov O.S., Latypova V.N., Grishchenko M.Y. Adrenal metastases: clinical manifestations and surgical outcomes. Onkourologiya = Cancer Urology 2018;14(2):79–87. (In Russ.). DOI: 10.17650/1726-9776-2018-14-2-79-87.

13. Muth A., Persson F., Jansson S. et al. Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol 2010;36(7):699–704. DOI: 10.1016/j.ejso.2010.04.002.

14. Shumarova S., Petrov D., Grozdev K. et al. Adrenalectomy for isolated metastases. J of IMAB 2017;23(3):1651–6. DOI: 10.5272/jimab.2017233.1651.

15. Hwang E.C., Hwang I., Jung S.I. et al. Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study. BMC Urol 2014;14:41. DOI: 10.1186/1471-2490-14-41.

16. Vazquez B.J., Richards M.L., Lohse C.M. et al. Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg 2012;36(6):1400–5. DOI: 10.1007/s00268-012-1506-3.

17. Weight C.J., Mulders P.F., Pantuck A.J., Thompson R.H. The role of adrenalectomy in renal cancer. Eur Urol Focus 2016;1(3):251–7. DOI: 10.1016/j.euf.2015.09.005.