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). Results:The median age of patients was 58 years; 93.5% were male, and 90.3% had hepatitis B virus infection. The median interval from HCC diagnosis to adrenal metastasis was 20.5 months. After adrenalectomy, the median recurrence-free survival was 7.5 months, and the median overall survival (OS) was 34.3 months. The 5- and 10-year survival rates were 42.3% and 32.6%, respectively. OS differed significantly across treatment groups (p = 0.008): median OS was 75.5 months in the liver resection group, compared to 33.8 months in the non-surgical group and 20.7 months in the liver transplantation group. 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.
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