Adrenal metastasectomy for oligometastatic non–small cell lung cancer in the era of immunotherapy and molecular-targeted therapy: outcomes and application of the ESTRO-EORTC oligometastatic classification in a single-institution surgical cohort

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Abstract
Background Adrenal metastasectomy for non–small cell lung cancer (NSCLC) has been reported mainly in historical series, and the ESTRO-EORTC oligometastatic classification has rarely been applied to surgical cohorts. We evaluated contemporary outcomes and applied this classification to a surgical adrenal cohort. Methods Consecutive patients who underwent adrenal metastasectomy for NSCLC at a single institution between 2011 and 2025 were retrospectively reviewed; small cell carcinoma and non-lung primary tumors were excluded. Overall, cancer-specific, recurrence-free, and post-recurrence survival were estimated by the Kaplan–Meier method. Each patient was assigned an ESTRO-EORTC category, and post-recurrence systemic therapy was recorded. Results Twenty-eight patients were analyzed (adenocarcinoma 79%; 61% operated in 2020 or later). Surgery was minimally invasive in 86%, with one Clavien–Dindo grade II event (blood transfusion), no grade ≥ III complication, and no 30-day mortality. Three-year overall survival was 60% and three-year cancer-specific survival 66%, whereas median recurrence-free survival was 5.6 months (2-year 25%) with recurrence in 75%; median post-recurrence survival was 32.1 months. Among 21 patients with recurrence, 18 (86%) received post-recurrence systemic therapy. In an exploratory comparison, oligorecurrence (n = 16) was associated with longer recurrence-free survival than all other ESTRO-EORTC states combined (n = 12; median 15.1 vs 3.7 months; hazard ratio 0.29, 95% confidence interval 0.12–0.71; log-rank p = 0.004). Conclusions Adrenal metastasectomy for NSCLC was safe and, despite frequent recurrence, was followed by prolonged survival in a highly selected cohort with frequent use of contemporary post-recurrence systemic therapy. Oligorecurrence was associated with longer recurrence-free survival than the other ESTRO-EORTC states combined.

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