FACTORS INFLUENCING ADRENAL METASTASIS IN RENAL-CELL CARCINOMA

The factors predisposing to adrenal, metastasis in renal cell carcinoma were reviewed in 695 cases. The overall incidence of adrenal metastasis was 4.3%. The risk of adrenal metastasis correlated with tumors that were on the left side, large and replacing the entire kidney, upper pole in location and of advanced T stage. Nevertheless, microscopic and/or contralateral adrenal metastasis was noted in patients with smaller, lower pole or mid renal tumors. Of 30 patients with adrenal metastasis 9 (30%) had clinical evidence of widespread disease. Among the patients who underwent complete surgical resection 14% had either positive lymph nodes or other nonadrenal metastases. Of the patients undergoing resection 81% died, with a mean postoperative survival of 27 months. Sustained disease-free survival was noted in 3 patients (0.43% of the entire series) whose complete pathological staging was pT1-3b, N0, M0. The need and benefit of adrenalectomy during surgery for renal cell carcinoma are extremely limited.