FACTORS INFLUENCING ADRENAL METASTASIS IN RENAL-CELL CARCINOMA

The factors predisposing to adrenal, metastasis in renal cell carcinom a were reviewed in 695 cases. The overall incidence of adrenal metasta sis was 4.3%. The risk of adrenal metastasis correlated with tumors th at were on the left side, large and replacing the entire kidney, upper pole in location and of advanced T stage. Nevertheless, microscopic a nd/or contralateral adrenal metastasis was noted in patients with smal ler, lower pole or mid renal tumors. Of 30 patients with adrenal metas tasis 9 (30%) had clinical evidence of widespread disease. Among the p atients who underwent complete surgical resection 14% had either posit ive lymph nodes or other nonadrenal metastases. Of the patients underg oing resection 81% died, with a mean postoperative survival of 27 mont hs. 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 ce ll carcinoma are extremely limited.