【摘要翻译】1635例肾细胞癌患者的肾上腺转移情况：肾上腺切除的结果和指征

[文题]ADRENAL METASTASES IN 1,635 PATIENTS WITH RENAL CELL CARCINOMA: OUTCOME AND INDICATION FOR ADRENALECTOMY.
1635例肾细胞癌患者的肾上腺转移情况：肾上腺切除的结果和指征
[来源]Journal of Urology.
[年、卷、期、页]2004. 171(6, Part 1 of 2):2155-2159
[作者]SIEMER, S.; LEHMANN, J.; KAMRADT, J.; LOCH, T.; REMBERGER, K.; HUMKE, U.; ZIEGLER, M.; STOCKLE, M.
[原文摘要]
Purpose: Routine removal of the ipsilateral adrenal gland in patients with renal cell carcinoma who undergo nephrectomy has been a matter of dispute. In a retrospective study we screened for subgroups of patients with renal cell carcinoma from a large single center patient population who may have benefited from ipsilateral adrenalectomy.
Materials and Methods: Radical nephrectomy was performed in 1,635 patients at a single institution between 1980 and 2000. A total of 1,010 patients underwent radical nephrectomy plus ipsilateral adrenalectomy, whereas in 625 no simultaneous adrenalectomy was performed. Numerous clinical and histopathological parameters were investigated by univariate and multivariate statistical methods for their predictive value in regard to cancer specific survival.
Results: Metastases in the adrenal gland were found in 5.5% of patients (56 of 1,010) undergoing nephrectomy with adrenalectomy. Of 30 patients with adrenal metastasis and preoperative computerized tomography/magnetic resonance imaging 23 were found to have histological evidence of cancer, approaching a false-negative rate of 23.3%. All patients with false-negative computerized tomography/magnetic resonance imaging had a primary tumor of greater than 4 cm. Patients with adrenal metastases predominately had pT3 or greater tumor stage (82%). Cancer specific survival rates (75% vs 73% for adrenalectomy vs no adrenalectomy) and postoperative complications rates (7% vs 8%) did not differ significantly between the 2 groups. The prognosis in patients with a solitary adrenal metastasis (18 of 56) was more favorable than in patients with additional metastatic sites (38 of 56).
Conclusions: Adrenal metastases from primary renal cell carcinoma were found significantly more often in patients with advanced tumor stages. Ipsilateral adrenalectomy should be recommended for all resectable renal cell carcinoma with a primary tumor of greater than 4 cm or with nonorgan confined tumor stages (T3 or greater) since a false-negative rate of about 20% can be expected with current imaging techniques.

[中文译文]
目的：肾细胞癌患者是否在行肾切除术时同时常规切除同侧肾上腺目前还存在争论。在此回顾性研究中，我们在一个大的中心调查了可能因同侧肾上腺切除术而获益的肾细胞癌患者。
材料与方法：1980-2000年该研究所行1635例根治性肾切除术。共1010例患者行根治性肾切除术同时行同侧肾上腺切除术，而625例未行肾上腺切除术。对大量的临床和病理学参数应用单变量和多元的统计方法计算关于肿瘤特异生存的预期值。
结果：肾切除同时行肾上腺切除的患者有5.5%（56/1010）存在肾上腺转移。30例有肾上腺转移同时术前行CT/MRI检查的患者中，23例发现有肿瘤证据，假阴性率为23.3%。所有CT/MRI假阴性的患者原发肿瘤均大于4cm。肾上腺转移的患者肿瘤分期大多数为pT3或更高（82%）。肿瘤特异生存率（肾上腺切除者75%，未行肾上腺切除者73%）和术后并发症率（7%，8%）两组无差异。肾上腺孤立转移灶的患者（18/56）预后较有多处转移灶者（38/58）为佳。
结论：原发肾细胞癌肾上腺转移在晚期肿瘤患者较多见。对于可以切除的原发肿瘤大于4cm或肿瘤超过肾脏限制（T3或更高）的患者推荐同时行同侧的肾上腺切除术，因为现在的影象技术有大约20%的假阴性率。

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[个人评论]根治同时切不切肾上腺，一直有争论，一般教科书都说切肾上腺的指征有1、影象检查肾上腺累及的，2、肿瘤比较大的（大到多少没有说），3、肿瘤位于肾上部的。此文章提出大于4cm就应当切除肾上腺，可是4cm实在不算大，实际上是放宽了切除肾上腺的指征。另外此文章没有统计肿瘤的位置是一个遗憾。