Department of Urology, National Defense Medical College, Tokorozawa, Japan.

Department of Urology, Women's Medical University, School of Medicine, Tokyo, Japan; Department of Urology, Keio University, School of Medicine, Tokyo, Japan; Department of Urology, Hamamatsu University, School of Medicine, Hamamatsu, Japan; Section for Medical Robotics and Surgical Device Creation, Research Center for Frontier Medical Engineering, Chiba University, Chiba, Japan; Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Fukuda Urological and Dermatological Clinic, Yokohama, Japan; Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan; and Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

We retrospectively review patients treated for renal cell carcinoma at 19 institutes in collaboration with the Japanese Society of Renal Cancer, to clarify the risk factors for ipsilateral adrenal involvement (IADI).

The clinicopathologic factors of the 30 patients with IADI were compared with those of the 926 control patients without IADI, and independent predictors for IADI were identified by multivariate analysis.

Preoperative computed tomography (CT) could detect 83.3% of the instances of synchronous ipsilateral adrenal metastasis. Patients with IADI had significantly larger primary tumors, higher pT stages and histologic grades, and higher percentages of upper pole involvement, microvascular invasion, spindle-cell-type tumors, lymph node metastasis (LNM), and distant metastasis (DM) outside the ipsilateral adrenal gland (IAd) than in control patients. Multivariate logistic regression analysis of clinical factors revealed that tumor size greater than 5.5 cm, pT stage of 3 or higher, LNM, and DM outside IAd, but not upper pole involvement, were significant predictors of IADI.

Tumor size greater than 5.5 cm, clinical T stage of 3 or higher (tumor for which pT stage of 3 or higher is suspected), LNM, and DM outside IAd seemed to be important preoperative indicators of IADI. These factors and CT findings would be useful preoperative indicators for ipsilateral adrenalectomy. Moreover, patients with renal cell carcinoma who have normal adrenal on CT, have a T1 tumor extending less than 5.5 cm, and have neither LNM nor DM are good candidates for adrenal-sparing nephrectomy.

Written by
Ito K, Nakazawa H, Marumo K, Ozono S, Igarashi T, Shinohara N, Fukuda M, Tsushima T, Naito S, Hayakawa M.

Reference
Urology. 2008 May 9. Epub ahead of print.

PubMed Abstract
PMID:18468657

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