Adrenalectomy Plus Nephrectomy Linked to Reduced Survival

Emma Hitt, PhD

May 19, 2012

May 19, 2012 (Atlanta, Georgia) — Overall survival is lower in patients with renal cell carcinoma who underwent radical nephrectomy with concurrent ipsilateral adrenalectomy than in patients with the ipsilateral adrenal gland left intact, according to a population-based study.

Stanley Yap, MD, from the Princess Margaret Hospital and Department of Health Policy at the University of Toronto, Ontario, Canada, and colleagues presented the findings in an oral podium poster session here at the American Urological Association 2012 Annual Scientific Meeting.

Renal cell carcinoma is the most common neoplasm that involves the kidney; it is often diagnosed in the late stage because of a lack of symptoms. Radial nephrectomy, which includes ipsilateral adrenalectomy, is the standard of care for large localized renal cell carcinoma tumors.

"Despite current evidence supporting ipsilateral adrenal-gland-sparing approaches during radical nephrectomy, such practices remain underutilized," Dr. Yap and colleagues note. "The long-term consequences of an iatrogenic solitary adrenal gland are poorly understood."

In this population-based study, the researchers examined data from pathology reports from the Ontario Cancer Registry, and compared overall survival between patients with renal cell carcinoma who had undergone ipsilateral adrenalectomy with those who had not. Overall survival and cancer-specific survival were calculated using Kaplan–Meier curves. Univariate and multivariate Cox proportional hazards models were also used for analysis.

From 1995 to 2004, the rate of ipsilateral adrenalectomy performed with renal nephrectomy was 30% in 1651 patients with a T1a renal tumor. Over a mean follow-up period of 9.1 years, the 10-year mortality rate was 26% in patients who had undergone ipsilateral adrenalectomy and 20% in patients in whom the ipsilateral adrenal gland was left intact.

In a multivariate analysis, worse overall survival was associated with an age of 70 to 79 years (hazard ratio [HR], 9.31; 95% confidence interval [CI], 5.89 to 14.94), high-grade renal cell carcinoma tumor (HR, 11.43; CI, 1.04 to 1.97), and ipsilateral adrenalectomy at the time of renal nephrectomy (HR, 1.23; 95% CI, 1.00 to 1.50). However, having undergone ipsilateral adrenalectomy was not associated with cancer-specific survival (HR, 1.18; 95% CI, 0.78 to 1.79).

"We demonstrate a significant association between performing ipsilateral adrenalectomy and overall survival," Dr. Yap and colleagues conclude in their abstract. "Our findings further support the importance of adrenal-sparing approaches at the time of renal nephrectomy."

The study was not commercially funded. Dr. Yap has disclosed no relevant financial relationships.

American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 52. Presented May 19, 2012.

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