Skip to main content
Erschienen in:

06.01.2022 | Endocrine Tumors

Survival After Adrenalectomy for Metastatic Lung Cancer

verfasst von: Lauren N. Krumeich, MD, MS, Robert E. Roses, MD, Lindsay E. Kuo, MD, MBA, Brenessa M. Lindeman, MD, MSE, Matthew A. Nehs, MD, Ali Tavakkoli, MD, Sareh Parangi, MD, Richard A. Hodin, MD, Douglas L. Fraker, MD, Benjamin C. James, MD, MS, Tracy S. Wang, MD, MPH, Carmen C. Solórzano, MD, Carrie C. Lubitz, MD, MPH, Heather Wachtel, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Adrenal metastasectomy is associated with increased survival in non-small cell lung cancer (NSCLC) with isolated adrenal metastases. Although clinical use of adrenal metastasectomy has expanded, indications remain poorly defined. The aim of this study was to evaluate the clinical benefit of adrenal metastasectomy for all lung cancer subtypes.

Patients and Methods

We performed a retrospective cohort study of patients who underwent adrenal metastasectomy for metastatic lung cancer at six institutions between 2001 and 2015. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Cox proportional hazards regressions and Kaplan–Meier survival analysis were performed.

Results

For 122 patients, the mean age was 60.5 years and 49.2% were female. Median time to detection of the metastasis was 11 months, and 41.8% were ipsilateral to the primary lung cancer. Median DFS was 40 months (1 year: 64.8%; 5 year: 42.9%). Factors associated with longer DFS included primary tumor resection [hazard ratio (HR): 0.001; p = 0.005], longer time to adrenal metastasis (HR: 0.94; p = 0.005), and ipsilateral metastases (HR: 0.13; p = 0.004). Shorter DFS corresponded with older age (HR: 1.11; p = 0.01), R1 resection (HR: 8.94; p = 0.01), adjuvant radiation (HR: 9.45; p = 0.02), and open adrenal metastasectomy (HR: 10.0; p = 0.03). Median OS was 47 months (1 year: 80.2%; 5 year: 35.2%). Longer OS was associated with ipsilateral metastasis (HR: 0.55; p = 0.02) and adjuvant chemotherapy (HR: 0.35; p = 0.02). Shorter OS was associated with extra-adrenal metastases at adrenalectomy (HR: 3.52; p = 0.007), small cell histology (HR: 15.0; p = 0.04), and lung radiation (HR: 3.37; p = 0.002).

Discussion

Durable survival was observed in patients undergoing adrenal metastasectomy and should be considered for isolated adrenal metastases of NSCLC. Small cell histology and extra-adrenal metastases are relative contraindications to adrenal metastasectomy.
Literatur
1.
Zurück zum Zitat Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.CrossRef Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.CrossRef
2.
Zurück zum Zitat Riihimäki M, Hemminki A, Fallah M, Thomsen H, Sundquist K, Sundquist J, et al. Metastatic sites and survival in lung cancer. Lung Cancer. 2014;86(1):78–84.CrossRef Riihimäki M, Hemminki A, Fallah M, Thomsen H, Sundquist K, Sundquist J, et al. Metastatic sites and survival in lung cancer. Lung Cancer. 2014;86(1):78–84.CrossRef
3.
Zurück zum Zitat Eberhardt WEE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A, et al. The IASLC lung cancer staging project. J Thorac Oncol. 2015;10(11):1515–22.CrossRef Eberhardt WEE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A, et al. The IASLC lung cancer staging project. J Thorac Oncol. 2015;10(11):1515–22.CrossRef
4.
Zurück zum Zitat Soffen EM, Solin LJ, Rubenstein JH, Hanks GE. Palliative radiotherapy for symptomatic adrenal metastases. Cancer. 1990;65(6):1318–20.CrossRef Soffen EM, Solin LJ, Rubenstein JH, Hanks GE. Palliative radiotherapy for symptomatic adrenal metastases. Cancer. 1990;65(6):1318–20.CrossRef
5.
Zurück zum Zitat Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg. 1996;62(6):1614–6.CrossRef Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg. 1996;62(6):1614–6.CrossRef
7.
Zurück zum Zitat Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer. 1998;82(2):389–94.CrossRef Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer. 1998;82(2):389–94.CrossRef
8.
Zurück zum Zitat Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg. 2001;71(3):981–5.CrossRef Porte H, Siat J, Guibert B, Lepimpec-Barthes F, Jancovici R, Bernard A, et al. Resection of adrenal metastases from non-small cell lung cancer: a multicenter study. Ann Thorac Surg. 2001;71(3):981–5.CrossRef
9.
Zurück zum Zitat Pfannschmidt J, Schlolaut B, Muley T, Hoffmann H, Dienemann H. Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer. Lung Cancer Amst Neth. 2005;49(2):203–7.CrossRef Pfannschmidt J, Schlolaut B, Muley T, Hoffmann H, Dienemann H. Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer. Lung Cancer Amst Neth. 2005;49(2):203–7.CrossRef
10.
Zurück zum Zitat Chen JYR, Ardestani A, Tavakkoli A. Laparoscopic adrenal metastasectomy: appropriate, safe, and feasible. Surg Endosc. 2014;28(3):816–20.CrossRef Chen JYR, Ardestani A, Tavakkoli A. Laparoscopic adrenal metastasectomy: appropriate, safe, and feasible. Surg Endosc. 2014;28(3):816–20.CrossRef
11.
Zurück zum Zitat Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non–small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008;26(7):1142–7.CrossRef Tanvetyanon T, Robinson LA, Schell MJ, Strong VE, Kapoor R, Coit DG, et al. Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non–small-cell lung cancer: a systematic review and pooled analysis. J Clin Oncol. 2008;26(7):1142–7.CrossRef
12.
Zurück zum Zitat Bartlett EK, Simmons KD, Wachtel H, Roses RE, Fraker DL, Kelz RR, et al. The rise in metastasectomy across cancer types over the past decade: metastasectomy trends. Cancer. 2015;121(5):747–57.CrossRef Bartlett EK, Simmons KD, Wachtel H, Roses RE, Fraker DL, Kelz RR, et al. The rise in metastasectomy across cancer types over the past decade: metastasectomy trends. Cancer. 2015;121(5):747–57.CrossRef
14.
Zurück zum Zitat Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.CrossRef Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.CrossRef
15.
Zurück zum Zitat Sobin LH, Hermanek P, Hutter RV. TNM classification of malignant tumors. A comparison between the new (1987) and the old editions. Cancer. 1988;61(11):2310–4.CrossRef Sobin LH, Hermanek P, Hutter RV. TNM classification of malignant tumors. A comparison between the new (1987) and the old editions. Cancer. 1988;61(11):2310–4.CrossRef
16.
Zurück zum Zitat Antonia SJ, Lopez-Martin JA, Bendell JC, Ott PA, Taylor MH, Eder JP, et al. Checkmate 032: nivolumab (N) alone or in combination with ipilimumab (I) for the treatment of recurrent small cell lung cancer (SCLC). J Clin Oncol. 2016;34(15_suppl):100.CrossRef Antonia SJ, Lopez-Martin JA, Bendell JC, Ott PA, Taylor MH, Eder JP, et al. Checkmate 032: nivolumab (N) alone or in combination with ipilimumab (I) for the treatment of recurrent small cell lung cancer (SCLC). J Clin Oncol. 2016;34(15_suppl):100.CrossRef
17.
Zurück zum Zitat Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627–39.CrossRef Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627–39.CrossRef
18.
Zurück zum Zitat Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WEE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373(2):123–35.CrossRef Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WEE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373(2):123–35.CrossRef
19.
Zurück zum Zitat Herbst RS, Baas P, Kim D-W, Felip E, Pérez-Gracia JL, Han J-Y, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–50.CrossRef Herbst RS, Baas P, Kim D-W, Felip E, Pérez-Gracia JL, Han J-Y, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–50.CrossRef
20.
Zurück zum Zitat Hirsch FR, Scagliotti GV, Mulshine JL, Kwon R, Curran WJ, Wu Y-L, et al. Lung cancer: current therapies and new targeted treatments. Lancet. 2017;389(10066):299–311.CrossRef Hirsch FR, Scagliotti GV, Mulshine JL, Kwon R, Curran WJ, Wu Y-L, et al. Lung cancer: current therapies and new targeted treatments. Lancet. 2017;389(10066):299–311.CrossRef
21.
Zurück zum Zitat Pant-Purohit M, Cheng L, Einhorn L. Apparent surgical cure for metastatic small cell lung cancer. J Thorac Oncol. 2008;3(6):682–3.CrossRef Pant-Purohit M, Cheng L, Einhorn L. Apparent surgical cure for metastatic small cell lung cancer. J Thorac Oncol. 2008;3(6):682–3.CrossRef
22.
Zurück zum Zitat Pham DC, Awad Z, Hoppe BS, Hew J, Ning K. Metastasectomy of solitary adrenal metastasis from small cell lung cancer. J Investig Med High Impact Case Rep. 2017;5(4):232470961774090.CrossRef Pham DC, Awad Z, Hoppe BS, Hew J, Ning K. Metastasectomy of solitary adrenal metastasis from small cell lung cancer. J Investig Med High Impact Case Rep. 2017;5(4):232470961774090.CrossRef
23.
Zurück zum Zitat Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51.CrossRef Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51.CrossRef
24.
Zurück zum Zitat Bazhenova L, Newton P, Mason J, Bethel K, Nieva J, Kuhn P. Adrenal metastases in lung cancer: clinical implications of a mathematical model. J Thorac Oncol. 2014;9(4):442–6.CrossRef Bazhenova L, Newton P, Mason J, Bethel K, Nieva J, Kuhn P. Adrenal metastases in lung cancer: clinical implications of a mathematical model. J Thorac Oncol. 2014;9(4):442–6.CrossRef
25.
Zurück zum Zitat Russo AE, Untch BR, Kris MG, Chou JF, Capanu M, Coit DG, et al. Adrenal metastasectomy in the presence and absence of extraadrenal metastatic disease. Ann Surg. 2019;270(2):373–7.CrossRef Russo AE, Untch BR, Kris MG, Chou JF, Capanu M, Coit DG, et al. Adrenal metastasectomy in the presence and absence of extraadrenal metastatic disease. Ann Surg. 2019;270(2):373–7.CrossRef
26.
Zurück zum Zitat Howell GM, Carty SE, Armstrong MJ, Stang MT, McCoy KL, Bartlett DL, et al. Outcome and prognostic factors after adrenalectomy for patients with distant adrenal metastasis. Ann Surg Oncol. 2013;20(11):3491–6.CrossRef Howell GM, Carty SE, Armstrong MJ, Stang MT, McCoy KL, Bartlett DL, et al. Outcome and prognostic factors after adrenalectomy for patients with distant adrenal metastasis. Ann Surg Oncol. 2013;20(11):3491–6.CrossRef
27.
Zurück zum Zitat Hu Z, Li Z, Ma Z, Curtis C. Multi-cancer analysis of clonality and the timing of systemic spread in paired primary tumors and metastases. Nat Genet. 2020;52(7):701–8.CrossRef Hu Z, Li Z, Ma Z, Curtis C. Multi-cancer analysis of clonality and the timing of systemic spread in paired primary tumors and metastases. Nat Genet. 2020;52(7):701–8.CrossRef
28.
Zurück zum Zitat Strong VE, D’Angelica M, Tang L, Prete F, Gönen M, Coit D, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14(12):3392–400.CrossRef Strong VE, D’Angelica M, Tang L, Prete F, Gönen M, Coit D, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14(12):3392–400.CrossRef
29.
Zurück zum Zitat Adler JT, Mack E, Chen H. Equal oncologic results for laparoscopic and open resection of adrenal metastases. J Surg Res. 2007;140(2):159–64.CrossRef Adler JT, Mack E, Chen H. Equal oncologic results for laparoscopic and open resection of adrenal metastases. J Surg Res. 2007;140(2):159–64.CrossRef
30.
Zurück zum Zitat Romero Arenas MA, Sui D, Grubbs EG, Lee JE, Perrier ND. Adrenal metastectomy is safe in selected patients. World J Surg. 2014;38(6):1336–42.CrossRef Romero Arenas MA, Sui D, Grubbs EG, Lee JE, Perrier ND. Adrenal metastectomy is safe in selected patients. World J Surg. 2014;38(6):1336–42.CrossRef
31.
Zurück zum Zitat Schmid S, Diem S, Li Q, Krapf M, Flatz L, Leschka S, et al. Organ-specific response to nivolumab in patients with non-small cell lung cancer (NSCLC). Cancer Immunol Immunother. 2018;67(12):1825–32.CrossRef Schmid S, Diem S, Li Q, Krapf M, Flatz L, Leschka S, et al. Organ-specific response to nivolumab in patients with non-small cell lung cancer (NSCLC). Cancer Immunol Immunother. 2018;67(12):1825–32.CrossRef
32.
Zurück zum Zitat Nishino M, Ramaiya NH, Chambers ES, Adeni AE, Hatabu H, Jänne PA, et al. Immune-related response assessment during PD-1 inhibitor therapy in advanced non-small-cell lung cancer patients. J Immunother Cancer. 2016;4(1):84.CrossRef Nishino M, Ramaiya NH, Chambers ES, Adeni AE, Hatabu H, Jänne PA, et al. Immune-related response assessment during PD-1 inhibitor therapy in advanced non-small-cell lung cancer patients. J Immunother Cancer. 2016;4(1):84.CrossRef
Metadaten
Titel
Survival After Adrenalectomy for Metastatic Lung Cancer
verfasst von
Lauren N. Krumeich, MD, MS
Robert E. Roses, MD
Lindsay E. Kuo, MD, MBA
Brenessa M. Lindeman, MD, MSE
Matthew A. Nehs, MD
Ali Tavakkoli, MD
Sareh Parangi, MD
Richard A. Hodin, MD
Douglas L. Fraker, MD
Benjamin C. James, MD, MS
Tracy S. Wang, MD, MPH
Carmen C. Solórzano, MD
Carrie C. Lubitz, MD, MPH
Heather Wachtel, MD
Publikationsdatum
06.01.2022
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-021-11192-7

Neu im Fachgebiet Chirurgie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

MedTalk Leitlinie KOMPAKT: S3-Leitline zu peripheren Nervenverletzungen

  • Webinar | 10.02.2025 | 13:00

Über den Weg zur finalen Fassung der S3-Leitlinie "Versorgung peripherer Nervenverletzungen" sprechen Prof. Dr. Leila Harhaus-Wähner und Ressortleiter Dr. Gunter Freese im WebTalk Leitlinie KOMPAKT, einer neuen Webcast-Serie von SpringerMedizin passend zu Ihrem Fachmagazin Orthopädie und Unfallchirurgie Mitteilungen und Nachrichten. In dem kurzen Video geht es darum, was sich im Vergleich zur vorigen Fassung der Leitlinie geändert hat, welche Aspekte für die tägliche Praxis besonders wichtig sind und was jeder gemäß Leitlinie nun anders oder besser machen sollte.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.