Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: A systematic review and pooled analysis
Outcomes of adrenalectomy for isolated synchronous versus metachronous adrenal metastases in non-small-cell lung cancer: A systematic review and pooled analysis
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DOI：
10.1200/jco.2007.14.2091
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发表时间：
2008-03-01
影响因子：
45.3
通讯作者：
Bepler, Gerold
中科院分区：
文献类型：
--
作者：
Tanvetyanon, Tawee;Robinson, Lary A.;Bepler, Gerold
目的几项小型研究报告称，对于非小细胞肺癌（NSCLC）孤立性肾上腺转移瘤的肾上腺切除术以及原发性肺癌的手术切除可以治愈。然而，一些人认为同步转移患者的生存结果很差。目前尚不清楚这种治疗方法对于同时转移的患者是否有效。方法通过 MEDLINE 数据库搜索有关 NSCLC 肾上腺切除术的出版物。包括报告生存结果并包含至少四名接受原发性肺癌手术的可分析患者的研究。那些不允许区分同步转移和异时转移的结果被排除在外。同步转移被定义为无病间隔 (DFI) 为 6 个月或更短。 结果 有 10 篇出版物贡献了 114 名患者； 42%的患者有同步转移，58%有异时转移。中位 DFI 分别为 0 个月和 12 个月。同步组的患者比异时组的患者更年轻（中位年龄 54 岁 vs 68 岁）。肾上腺切除术的并发症很少见。同时转移患者的中位总生存期比异时转移患者短（12 个月 vs 31 个月，广义 Wilcoxon P 值 = 0.02）。然而，5 年生存率估计值分别为 26% 和 25%。 结论 对于 NSCLC 的孤立性肾上腺转移，接受肾上腺切除术的同步转移患者的中位总生存期比异时转移患者短。然而，两组中约有 25% 的患者实现了持久的长期生存。
PurposeSeveral small studies have reported that an adrenalectomy for isolated adrenal metastasis in non-small-cell lung cancer (NSCLC), along with a surgical resection for the primary lung cancer, can be curative. However, some suggest that the survival outcome among patients with a synchronous metastasis is poor. It remains unclear whether this treatment approach is warranted among those with synchronous metastasis.MethodsA search for publications on adrenalectomy for NSCLC was performed via the MEDLINE database. Studies reporting on survival outcomes and containing at least four analyzable patients who had surgery for primary lung cancer were included. Those not allowing separation of outcomes between synchronous and metachronous metastases were excluded. Synchronous metastasis was defined as a disease-free interval (DFI) of 6 months or less.ResultsThere were 10 publications contributing 114 patients; 42% of patients had synchronous metastases and 58% had metachronous metastases. The median DFIs were 0 and 12 months, respectively. Patients in the synchronous group were younger than those in the metachronous group (median age 54 v 68 years). Complications from adrenalectomy were infrequent. Median overall survival was shorter for patients with synchronous metastasis than those with metachronous metastasis (12 months v 31 months, generalized Wilcoxon P value = .02). However, the 5-year survival estimates were equivalent at 26% and 25%, respectively.ConclusionFor an isolated adrenal metastasis from NSCLC, patients with a synchronous metastasis who underwent adrenalectomy had a shorter median overall survival than those with a metachronous metastasis. However, a durable long-term survival is achieved in approximately 25% in both groups.