Factors Affecting Adrenal Gland Involvement in Patients Who Underwent Radical Nephrectomy for Renal Cell Carcinoma
Aim: We investigated pathological characteristics of adrenal involvement in patients who underwent radical nephrectomy (RN) for renal cell carcinoma (RCC). Materials and Methods: 49 patients (34 male, 15 female) who underwent RN and simultaneous ipsilateral adrenalectomy due to RCC were included. Patient and tumor characteristics, histopathologic features, disease stage, and radiologic computerized tomography (CT) features were studied in order to see if any of them are associated with pathological evidence of adrenal involvement. Results: Presence of adrenal irregularity (P = 0.002), venous thrombosis (P = 0.010), tumor necrosis (P = 0.031), and lymph node (LN) involvement (P = 0.013) on CT, increased Fuhrman grade (P = 0.037), and presence of capsular invasion (P = 0.027) and perirenal fatty tissue invasion by RCC (P = 0.011) were found to be significantly associated with ipsilateral adrenal involvement. There was no statistically significant association with location of the tumor in the upper pole of the kidney (P = 0.077), increased tumor size (P = 0.098), pathologic stage (P = 0.085), presence of vascular invasion (P = 0.067), and metastasis despite higher incidence of them in the group with adrenal involvement. Conclusions: Risk factors for ipsilateral adrenal involvement by RCC appear to be the presence of adrenal gland irregularity, venous thrombosis and necrosis on CT, increased Fuhrman grade, presence of capsular and peripheral fatty tissue invasion, LN involvement, and metastasis. Therefore, we recommend ipsilateral adrenalectomy particularly in this patient group.
Factors Affecting Adrenal Gland Involvement in Patients Who Underwent Radical Nephrectomy for Renal Cell Carcinoma
Aim: We investigated pathological characteristics of adrenal involvement in patients who underwent radical nephrectomy (RN) for renal cell carcinoma (RCC). Materials and Methods: 49 patients (34 male, 15 female) who underwent RN and simultaneous ipsilateral adrenalectomy due to RCC were included. Patient and tumor characteristics, histopathologic features, disease stage, and radiologic computerized tomography (CT) features were studied in order to see if any of them are associated with pathological evidence of adrenal involvement. Results: Presence of adrenal irregularity (P = 0.002), venous thrombosis (P = 0.010), tumor necrosis (P = 0.031), and lymph node (LN) involvement (P = 0.013) on CT, increased Fuhrman grade (P = 0.037), and presence of capsular invasion (P = 0.027) and perirenal fatty tissue invasion by RCC (P = 0.011) were found to be significantly associated with ipsilateral adrenal involvement. There was no statistically significant association with location of the tumor in the upper pole of the kidney (P = 0.077), increased tumor size (P = 0.098), pathologic stage (P = 0.085), presence of vascular invasion (P = 0.067), and metastasis despite higher incidence of them in the group with adrenal involvement. Conclusions: Risk factors for ipsilateral adrenal involvement by RCC appear to be the presence of adrenal gland irregularity, venous thrombosis and necrosis on CT, increased Fuhrman grade, presence of capsular and peripheral fatty tissue invasion, LN involvement, and metastasis. Therefore, we recommend ipsilateral adrenalectomy particularly in this patient group.
___
- Alamdari FI, Ljungberg B. Adrenal metastasis in renal cell carcinoma: A recommendation for adjustment of the TNM staging system. Scand J Urol Nephrol 2005; 39: 277-282.
- Tsui KH, Shvarts O, Barbaric Z, Figlin R, DeKernion JB, Belldegrun A. Is adrenalectomy a necessary component of radical nephrectomy? UCLA experience with 511 radical nephrectomise. J Urol 2000; 163: 437-441.
- Moudouni SM, En-nia I, Manunta A, Guille F, Lobel B. Factors influencing adrenal metastasis in renal cell carcinoma. Int Urol Nephrol 2003; 35: 141-147.
- Kozlowski J. Management of distant solitary recurrence in the patient with renal cancer: contralateral kidney and other sites. Urol Clin North Am 1994; 21: 601-24.
- Wunderlich H, Schlichter A, Reichelt O, Zermann DH, Janitzky V, Kosmehl H et al. Real indications for adrenalectomy in renal cell carcinoma. Eur Urol 1999; 35: 272-6.
- von Knobloch R, Seseke F, Riedmiller H, gröne HJ, Walthers EM, Kalble T. Radical nephrectomy for renal cell carcinoma: is adrenalectomy necessary? Eur Urol 1999; 36: 303-308.
- Leibovitch I, Raviv G, Mor Y, Nativ O, Goldwasser B. Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma. Urology 1995; 46: 316-320.
- Shalev M, Cipolla B, Guille F, Staerman F, Lobel B. Is ipsilateral adrenalectomy a necessary component of radical nephrectomy? J Urol 1995; 153: 1415-1417.
- Kuczyk M, Munch T, Machtens S, Bokemeyer C, Wefer A, Hartmann J et al. The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hanover experience. BJU Int 2002; 89: 517-522.
- Antonelli A, Cozzoli A, Simeone C, Zani D, Zanotelli T, Portesi E et al. Surgical treatment of adrenal metastasis from renal cell carcinoma: a single-centre experience of 45 patients. BJU Int 2006; 97: 505-508.
- Lee MJ, Hahn PF, Papanicolaou N, Egglin TK, Saini S, Mueller PR et al. Benign and malignant adrenal masses: CT distinction with attenuation coefficients, size and observer analysis. Radiology 1991; 179: 415-18.
- Reinig JW, Stutley JE, Leonhardt CM, Spicer KM, Margolis M, Caldwell CB. Differentiation adrenal metastasis with MR imaging: comparison of techniques. Radiology 1994; 192: 41-46.
- Atan A, Tuncel A, Aslan Y, Çaşkurlu T, Eroğlu M, Albayrak S et al. Is computerized tomography reliable for detecting tumor number and adrenal gland involvement in patients with renal cell cancer? A multicenter study. Türk Üroloji Dergisi 2005; 31: 329-334.
- Moudouni SM, En-nia I, Patard JJ, Manunta A, Guille F, Lobel B. Real indications for adrenalectomy in renal cell carcinoma. Scand J Urol Nephrol 2002; 36(4): 273-277.
- Fuhrman SA, Lasky LC, Limas CL. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982; 6: 655-663.
- Ito A, Satoh M, Ohyama C, Saito S, Shintaku I, Nakano O et al. Adrenal metastasis from renal cell caecinoma: Significance of adrenalectomy. Int J Urol 2002; 9: 125-128.
- Ito K, Nakazawa H, Marumo K, Ozono S, Igarashi T, Shinohara N et al. Risk factors for ipsilateral adrenal involvement in renal cell carcinoma. Urology 2008; 72(2): 354-8.
- Ito K, Mizuguchi Y, Sato A, Kuroda K, Horiguchi A, Kimura F et al. Clinical evaluation for adrenal metastasis of renal cell carcinoma in a single institute. Nippon Hinyokika Gakkai Zasshi. 2008; 99(4): 584-92.
- Jung SJ, Ro JY, Truong LD, Ayala AG, Shen SS. Reappraisal of T3N0/NxM0 renal cell carcinoma: significance of extent of fat invasion, renal vein invasion, and adrenal invasion. Hum Pathol 2008 Jul 23 [Epub ahead of print].