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Open Access Research article

Prognostic factors for recurrence-free and overall survival after adrenalectomy for metastatic carcinoma: a retrospective cohort pilot study

Eu Chang Hwang1, Insang Hwang1, Seung Il Jung1, Taek Won Kang1, Dong Deuk Kwon1, Suk Hee Heo2, Jun Eul Hwang3, Sung Gu Kang4*, Seok Ho Kang4, Jeong Gu Lee4, Je Jong Kim4 and Jun Cheon4

Author Affiliations

1 Department of Urology, Chonnam National University Medical School, Gwangju, Korea

2 Department of Radiology, Chonnam National University Medical School, Gwangju, Korea

3 Department of Hemato-oncology, Chonnam National University Medical School, Gwangju, Korea

4 Department of Urology, Korea University School of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea

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BMC Urology 2014, 14:41  doi:10.1186/1471-2490-14-41

Published: 23 May 2014

Abstract

Background

The survival benefits of adrenalectomy (ADx) in the setting of metastatic cancer and prognostic factors for recurrence-free (RFS) and overall survival (OS) after adrenalectomy for metastatic carcinoma are still under debate. We evaluated the impact of clinicopathological variables on RFS and OS after ADx for metastatic carcinoma in patients with primary cancer.

Methods

A total of 32 patients undergoing ADx for metastatic cancer between 2004 and 2012 at two tertiary medical centers. Metastases were regarded as synchronous (<6 months) or metachronous (≥6 months) depending on the interval after primary surgery. Associations of perioperative clinicopathologic variables with RFS and OS were analyzed using Cox regression models.

Results

In total, 32 patients received ADx for metastatic primary tumors located in the lung (n = 11), colon (n = 4), liver (n = 5), stomach (n = 3), kidney (n = 4), pancreas (n = 2), glottis, esophagus, cervix, and ovary (n = 1 each). The overall recurrence rate after adrenalectomy was 62.5% (n = 20). By univariate analysis, C-reactive protein, inflammation-based prognosis score, and adrenalectomy for curative intent were associated with RFS and OS. Independent prognostic factors for shorter RFS were operative method (laparoscopy HR 4.68, 95% CI 1.61-13.61, p = 0.005) and inflammation-based prognostic score (HR 11.8, 95% CI 2.50-55.7, p = 0.002). For shorter OS, synchronous metastasis (HR 3.05, 95% CI 1.07-11.94, p = 0.048) and inflammation-based prognostic score (HR 6.65, 95% CI 1.25-35.23, p = 0.026) were identified as independent prognostic factors.

Conclusions

Our pilot study suggests that synchronous disease and inflammation-based prognostic score are significant prognostic factors for survival and should be considered when performing ADx for metastatic diseases.

Keywords:
Adrenalectomy; Neoplasm metastasis; Prognosis; Survival