A Comprehensive Survey on the Progress, Process, and Challenges of Lung Cancer Detection and Classification
Table 13
Best articles and their details.
Author info
Patient group
Outcomes
Key results
Comments
Raz et al. [417](USA) (retrospective cohort study (level 4, good))
37 patients identified with isolated adrenal metastases from NSCLC
5-year survival
34% in the adrenalectomy group versus 0% in the non-operative group ()
The selection process for operative and non-operative management was inconsistent
20 underwent surgical resection
83% for ipsilateral tumors versus 0% for contralateral tumors ()
Adrenalectomy patients were on average 10 years younger
17 underwent non-operative management
67% in case of lower lobe NSCLC versus 27% in cases of upper lobe tumors ()
50% of patients in the adrenalectomy group (and 70% in the non-operated group) had N2 or T4 diseases; therefore, the adrenal metastasis was not truly isolated
Maximum follow-up period of 16 years
27% synchronous metastasis versus 41% metachronous metastases ()
Significant variability in treatment with chemotherapy and radiotherapy
52% with N0 or N1 disease versus 0% with N2 diseases ()
Luketich and Burt [418] (USA) (retrospective cohort study (level 4, good))
14 patients with isolated synchronous adrenal metastasis from NSCLC
Medium survival
Medium survival of 8.5 months in the chemotherapy alone group versus 31 months in the chemotherapy + surgery group
Small study, but no significant differences were seen in preoperative characteristics, tumor size, or cell type to otherwise explain the improved survival
8 patients had neoadjuvant chemotherapy followed by concomitant lung resection and adrenalectomy
In the surgically resected group, the 3-year actuarial survival was 38%
6 patients had only 3 cycles of chemotherapy (mitomycin, cisplatin, and vinblastine)
Longest survivor at end of follow-up was 61 months
The authors recommend that surgery should be advocated after ensuring that curative resection of the lung primary can be achieved
5-year follow-up
Higashiyama et al. [416] (retrospective cohort study (level 4, good))
9 patients with isolated adrenal metastases from surgically resected lung cancer (4 non-curative and 5 curative)
Survival
Adrenalectomy group: 2/5 alive at 24 and 40 months, respectively, and 3/5 died at 9, 17, and 20 months, respectively
All patients in the palliative group had a disease-free interval of 7 months. This selection bias may explain some of the observed difference in survival in addition to the influence of treatment strategy.
5 treated with adrenalectomy followed by adjuvant chemo or radiotherapy
4 treated with palliative chemo or radiotherapy
Palliative group: all died within 6 months
The authors concluded that short FDIs are probably due to lymphatic spread and probably signify a more aggressive tumor
