Prognostic factors after adrenalectomy for adrenal metastasis
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UROLOGY - ORIGINAL PAPER
Prognostic factors after adrenalectomy for adrenal metastasis A. Goujon1 · N. Schoentgen2 · R. Betari3 · M. Thoulouzan4 · V. Vanalderwerelt5 · S. Oumakhlouf6 · N. Brichart7 · B. Pradere5 · M. Roumiguie4 · A. Rammal7 · M. Soulie4 · G. Fournier2 · K. Bensalah1 · F. Bruyere5 · P. Grise6 · V. Joulin2 · A. Manunta1 · F. Saint3 · E. Huyghe4 · F.‑X. Nouhaud6 · B. Peyronnet1 Received: 28 January 2020 / Accepted: 4 May 2020 © Springer Nature B.V. 2020
Abstract Purpose Very few studies have sought prognostic factors after adrenalectomy for metastasis. The aim of this study was to assess prognostic factors for oncological outcomes after adrenalectomy for adrenal metastasis. Methods All adrenalectomies for metastases performed in seven centers between 2006 and 2016 were included in a retrospective study. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method. Prognostic factors for CSS and RFS were sought by Cox regression analyses. Results 106 patients were included. The primary tumors were mostly renal (47.7%) and pulmonary (32.3%). RFS and CSS estimated rates at 5 years were 20.7% and 63.7%, respectively. In univariate analysis, tumor size (HR 3.83; p = 0.04) and the metastasis timing (synchronous vs. metachronous; HR 0.47; p = 0.02) were associated with RFS. In multivariate analysis, tumor size (HR 8.28; p = 0.01) and metastasis timing (HR 18.60; p = 0.002) were significant factors for RFS. In univariate analysis, the renal origin of the primary tumor (HR 0.1; p 18 years old and were treated with curative intent. The study received the approval of the local ethics committees. We used the French claim database (PMSI) using the CPT codes for adrenalectomy (KEFC002—partial or total adrenalectomy, transperitoneal or retroperitoneal laparoscopic surgery; KEFA002—partial or total adrenalectomy, open surgery). For comprehensiveness, the list of patients was then screened for inclusion based on computerized individual patients’ charts. The national health system has a pay per use model; all the surgeons have to enter a CPT code for each surgery. Suspicion of adrenal metastasis was defined as any adrenal mass diagnosed in a patient with any history of neoplasm or any coexistent neoplasm. The indications for adrenalectomy were discussed in interdisciplinary tumor boards and included suspicion of adrenal metastasis either clinically isolated or in patients with oligometastatic disease whenever all metastatic sites were amenable to treatment with curative intent. Prior to surgery, all patients underwent a thoracic and abdominal contrast-enhanced computed tomography (CT
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International Urology and Nephrology
scan) and an endocrinologic evaluation. Fluorodeoxyglucose positron emission tomography (FDG-PET) was performed at the physician’s discretion.
Surgical techniques The choice of an open approach, a laparoscopic transperitoneal, or a laparoscopic retroperitoneal approach was left to surgeon’s discretion. Owing to the retrospective multicenter
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