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Risk factors for ipsilateral adrenal involvement in renal cell carcinoma

Keiichi Ito1, Hayakazu Nakazawa, Ken Marumo

  • 1Department of Urology, National Defense Medical College, Tokorozawa, Japan. itok@ndmc.ac.jp

Urology
|May 13, 2008
PubMed
Abstract

Insights

Large renal cell carcinoma tumors (>5.5 cm), advanced stage, lymph node metastasis, and distant metastasis are key indicators of ipsilateral adrenal involvement. These factors aid in surgical planning for renal cell carcinoma.

Area of Science:

  • Urology
  • Oncology
  • Radiology

Background:

  • Renal cell carcinoma (RCC) can involve the ipsilateral adrenal gland.
  • Identifying risk factors for ipsilateral adrenal involvement (IADI) is crucial for treatment planning.

Purpose of the Study:

  • To identify clinicopathologic risk factors for ipsilateral adrenal involvement (IADI) in patients with renal cell carcinoma (RCC).

Main Methods:

  • Retrospective review of 956 RCC patients from 19 institutes.
  • Comparison of clinicopathologic factors between 30 patients with IADI and 926 controls.
  • Multivariate logistic regression analysis to identify independent predictors of IADI.

Main Results:

  • Preoperative CT detected 83.3% of synchronous ipsilateral adrenal metastases.
  • Patients with IADI had larger tumors, higher pT stages, higher histologic grades, and more frequent upper pole involvement, microvascular invasion, spindle-cell tumors, lymph node metastasis (LNM), and distant metastasis (DM) outside the ipsilateral adrenal gland (IAd).
  • Significant predictors of IADI included tumor size >5.5 cm, pT stage ≥3, LNM, and DM outside IAd.

Conclusions:

  • Tumor size >5.5 cm, clinical T stage ≥3, LNM, and DM outside IAd are important preoperative indicators of IADI.
  • These factors, along with CT findings, can guide decisions regarding ipsilateral adrenalectomy.
  • Patients with early-stage tumors (<5.5 cm, T1), no LNM, and no DM are candidates for adrenal-sparing nephrectomy.

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