Survival outcomes and prognostic predictors after adrenalectomy for renal cell carcinoma adrenal metastasis

To evaluate survival outcomes after adrenalectomy for renal cell carcinoma (RCC) adrenal metastasis and to identify risk factors influencing overall survival.

We retrospectively reviewed all histologically confirmed cases of RCC adrenal metastasis managed at a tertiary center from January 2013 to December 2024. Overall survival (OS) was estimated with Kaplan-Meier analysis and compared with log-rank tests. Prognostic factors were examined using univariable and multivariable Cox proportional hazards models.

A total of 82 patients with RCC adrenal metastasis were included (median age 60.5 years; IQR 54.8-67.0). Metachronous disease was present in 52 patients (63.4%), and 8 (9.8%) had bilateral adrenal involvement. Seventy-one patients (86.6%) underwent adrenalectomy; seven with bilateral primary renal tumors were excluded owing to indeterminate timing and/or laterality, leaving 64 for survival analysis. After a median follow-up of 32.5 months (IQR 14.8-80.8), the 1-, 3-, and 5-year OS rates were 96.6% (95% CI 92.2-100.0%), 87.1% (95% CI 77.8-97.6%), and 74.4% (95% CI 61.4-90.2%), respectively. Log-rank analysis showed poorer OS for synchronous presentation (P = 0.02), RCC T3/4 stage (P < 0.001), and primary tumor diameter > 6 cm (P = 0.001). In multivariable Cox analysis, increasing primary tumor diameter was the only independent predictor of reduced OS (HR 1.33, 95% CI 1.02-1.75; P = 0.04).

Adrenalectomy provides durable survival for well-selected patients with isolated or oligometastatic RCC adrenal metastasis. Prospective multicenter trials comparing surgery with non-surgical modalities are needed to refine management algorithms.