Objective: To analyze the clinical characteristics, etiological composition, imaging features, and prognosis of adrenal metastases. Methods: This study is a retrospective case series that included 96 patients with pathologically confirmed adrenal metastases who were treated at West China Hospital, Sichuan University, from 2007 to 2017. Clinical features such as sex, age, tumor size, biochemical tests, imaging characteristics, postoperative pathology, treatment methods, and prognosis were collected and analyzed. The prognosis of patients and its influencing factors were analyzed by Kaplan-Meier survival curve and single-factor Cox risk proportional model. Results: Among the 96 included patients, 64 were male and 32 were female, with a median age of 60 years. There were 89 cases of unilateral adrenal metastases, five cases of bilateral metastases, and two cases with unspecified laterality. The median diameter of the metastases was 3.5 cm×2.9 cm, with an average CT value of 31 HU. Thirty-four cases of adrenal hormones were evaluated, and no abnormality was found.The primary tumor sites were as follows: lung (n=36), kidney (n=19), liver (n=12), pancreas (n=7), rectum (n=3), stomach (n=2), and one case each of tumor in the esophagus, skin, thyroid, left maxillary muscle, breast, bladder, cervix, chest wall, and gastrointestinal tract. There were three cases with unknown primary tumors. The most common pathological type was lung adenocarcinoma (20.8%, 20/96), followed by hepatocellular carcinoma (9.4%, 9/96) and high-grade invasive urothelial carcinoma of the kidney (8.3%, 8/96). Thirty-nine cases were diagnosed concurrently with the primary tumor, while 37 cases were diagnosed after the primary tumor, with a median interval of 15 months (range: 2-144 months). There was no significant correlation between the death risk of adrenal metastatic tumor patients and gender, age, and the size of the metastatic tumor (all P>0.05). There were 4 patients with radiotherapy and chemotherapy alone, 19 patients with surgery alone, and 6 patients with combined radiotherapy and chemotherapy. The median overall survival was 1, 3, and 7 years, respectively. Conclusions: Adrenal metastases were mostly diagnosed at the same time as the primary tumor or within 15 months after the diagnosis of the primary tumor. Unilateral metastasis is common. The lungs are the most common primary lesion, followed by the kidney and liver. CT is the preferred method for the diagnosis of adrenal metastases, and the plain CT value is more than 30 HU. The overall prognosis of adrenal metastases is poor. The prognosis was better for patients who underwent surgery combined with radiotherapy and chemotherapy than those who received only surgery or radiotherapy and chemotherapy alone.
目的： 分析肾上腺转移瘤的临床特点、病因构成、影像学特征及预后。 方法： 回顾性病例系列研究。收集2007至2017年在四川大学华西医院诊治的96例经组织病理学诊断为肾上腺转移瘤的患者，整理并分析性别、年龄、肿瘤大小、生化检验、影像特征、术后病理、治疗方式及预后等临床特点。患者预后及其影响因素分别采用Kaplan-Meier生存曲线及单因素Cox风险比例模型分析。 结果： 纳入的96例肾上腺转移瘤患者中，男性64例，女性32例，中位年龄60岁。89例肿瘤位于单侧，5例位于双侧，2例左右侧不详。转移瘤大小的中位值为3.5 cm×2.9 cm，平扫CT平均值31 HU。34例患者评估了肾上腺各项激素检测均无异常。原发灶肿瘤部位依次为：肺36例，肾19例，肝脏12例，胰腺7例，直肠3例，胃2例，食管、皮肤、甲状腺、左上颌肌、乳腺、膀胱、宫颈、胸壁、胃肠道各1例，原发灶不明的3例。组织病理学类型以肺腺癌最多见，占20.8%（20/96），其次为肝细胞癌及肾脏高级别浸润性尿路上皮癌，分别占9.4%（9/96）和8.3%（8/96）。39例肾上腺转移瘤与原发灶同期确诊；37例为确诊原发肿瘤后诊断，距离原发肿瘤诊断的中位时间15个月（范围2~144个月）。肾上腺转移瘤患者的死亡风险与性别、年龄、转移瘤的大小均无显著相关（均P>0.05）。单纯放化疗患者4例，单纯手术患者19例，手术联合放化疗患者6例，中位总生存期分别为1、3、7年。 结论： 肾上腺转移瘤多数在原发肿瘤发现的同期或确诊原发灶后15个月内诊断，单侧转移多见。肺脏为最常见的原发病灶，其次为肾脏、肝脏。CT是诊断肾上腺转移瘤的首选方法，平扫CT值多>30 HU。肾上腺转移瘤总体预后差，手术联合放化疗者预后好于单纯手术者及单纯放化疗者。.