Clinical outcomes and prognostic factors after adrenalectomy for adrenal metastasis from hepatocellular carcinoma

Backgrounds/Aims: Adrenal metastasis from hepatocellular carcinoma (HCC) is uncommon, and the role of surgical resection remains undefined. This study analyzed clinical outcomes and prognostic factors in patients who underwent adrenalectomy for adrenal metastasis from HCC at a single tertiary center. Methods: We retrospectively analyzed 31 patients who underwent adrenalectomy for adrenal metastasis from HCC (2002-2019), classified by initial HCC treatment: liver resection (n = 17), liver transplantation (n = 7), and non-surgical management (n = 7). On multivariate Cox regression, prior liver resection was independently associated with reduced mortality. Conclusions: Adrenalectomy was associated with prolonged OS in selected patients with adrenal metastasis from HCC, particularly those with prior liver resection. Given the high recurrence rate and the lack of a non-surgical comparator, these findings warrant cautious interpretation. Adrenalectomy may be considered within a multidisciplinary framework for carefully selected patients, pending confirmation by prospective multicenter studies.