Outcomes of patients with isolated adrenal metastasis from non-small cell lung carcinoma.

BACKGROUND: Long-term survival of patients who undergo surgical resection of isolated adrenal metastasis from non-small cell lung cancer (NSCLC) has been reported. The aim of this study was to compare survival of patients who underwent adrenalectomy with those treated nonoperatively, and to analyze clinical characteristics associated with long-term survival.

METHODS: Between January 1994 and July 2010, 37 patients with isolated adrenal metastasis from NSCLC were identified. Twenty patients underwent adrenalectomy. Patients did not undergo adrenalectomy owing to suspicion of N2 disease, medical comorbidities, or patient preference. Seven patients (35%) treated surgically had tumors that were ipsilateral to their primary tumor, and 8 (40%) had metachronous metastases.

RESULTS: Five-year overall survival was 34% for patients treated operatively and 0% for patients treated nonoperatively p = 0.002). Among patients treated with adrenalectomy, patients with ipsilateral metastases had a 5-year survival of 83% compared with 0% for patients with contralateral metastases (p = 0.003). Patients without mediastinal nodal disease had a 5-year survival of 52% compared with 0% for patients with mediastinal nodal disease (p = 0.008). Survival of patients who underwent adrenalectomy for synchronous and metachronous adrenal metastases was not significantly different (p = 0.81).

CONCLUSIONS: Surgical resection of isolated adrenal metastasis from lung cancer provides a survival benefit in well-selected patients compared with nonoperative management. No patient with contralateral adrenal metastases or mediastinal nodal disease survived long term after adrenalectomy. The time interval between treatment of the primary lung cancer and adrenal metastasis was not significantly associated with survival, but the cohort size was small.