Factors Affecting Adrenal Gland Involvement in Patients Who Underwent Radical Nephrectomy for Renal Cell Carcinoma

Authors: ZİYA AKBULUT, MEHMET TUZLALI, ABDULLAH ERDEM CANDA, KARABEKİR ERCAN, OLCAY KANDEMİR, M. DERYA BALBAY

Abstract: Aim: We investigated pathological characteristics of adrenal involvement in patients who underwent radical nephrectomy (RN) for renal cell carcinoma (RCC). Materials and Methods: 49 patients (34 male, 15 female) who underwent RN and simultaneous ipsilateral adrenalectomy due to RCC were included. Patient and tumor characteristics, histopathologic features, disease stage, and radiologic computerized tomography (CT) features were studied in order to see if any of them are associated with pathological evidence of adrenal involvement. Results: Presence of adrenal irregularity (P = 0.002), venous thrombosis (P = 0.010), tumor necrosis (P = 0.031), and lymph node (LN) involvement (P = 0.013) on CT, increased Fuhrman grade (P = 0.037), and presence of capsular invasion (P = 0.027) and perirenal fatty tissue invasion by RCC (P = 0.011) were found to be significantly associated with ipsilateral adrenal involvement. There was no statistically significant association with location of the tumor in the upper pole of the kidney (P = 0.077), increased tumor size (P = 0.098), pathologic stage (P = 0.085), presence of vascular invasion (P = 0.067), and metastasis despite higher incidence of them in the group with adrenal involvement. Conclusions: Risk factors for ipsilateral adrenal involvement by RCC appear to be the presence of adrenal gland irregularity, venous thrombosis and necrosis on CT, increased Fuhrman grade, presence of capsular and peripheral fatty tissue invasion, LN involvement, and metastasis. Therefore, we recommend ipsilateral adrenalectomy particularly in this patient group.

Keywords: Renal cancer, adrenal involvement, risk factors

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