Nomograms for the Prediction of Survival for Patients with Pediatric Adrenal Cancer after Surgery

Abstract

Purpose: To develop and validate a nomogram to postoperatively evaluate overall survival (OS) and cancer-specific survival (CSS) in patients with pediatric adrenal cancer. Methods: In total, 847 eligible patients diagnosed between 1988 and 2015 form the Surveillance Epidemiology, and End Results (SEER) database were enrolled in this study according to the specified inclusion and exclusion criteria. They were divided into a training set (n = 661) and a validation set (n = 186). Multivariate Cox proportional hazards regression algorithm was used to identify the independent predictors of OS and CSS in the training set, and develop the predicting models, which were presented two nomograms. The performance of the nomograms (discrimination, calibration and clinical usefulness) was assessed in the training set and validated in the validation set. Results: Based on the multivariate Cox proportional hazards regression analyses, three independent predictors including age at diagnosis, tumor size and M stage were identified for both OS and CSS. Then, an OS nomogram and a CSS nomogram were developed incorporating these three predictors, respectively. The OS nomogram showed good calibration and discrimination in the training set (C-index [95% CI], 0.744 [0.711-0.777]), which was confirmed in the validation set (C-index [95% CI], 0.746 [0.656-0.836]). Favorable calibration and discrimination of the CSS nomogram were also observed in the training set (C-index [95% CI], 0.749 [0.715-0.783]) and validation set (C-index [95% CI], 0.789 [0.710-0.868]). Moreover, the nomograms successfully distinguished patients with high risk of all-cause and cancer-specific mortality in all patients and in the stratified analyses. Decision curve analysis demonstrated the usefulness of the nomograms. Conclusion: The presented nomograms show favorable predictive accuracy for OS and CSS in patients with pediatric adrenal cancer after surgery. Further validation is warranted prior to clinical implementation.

Estimation of the tumor size at cure threshold among adult patients with adrenocortical carcinoma: A populational-based study

“…The genomic characteristics of ACC are different between pediatric and adult patients, and the prognosis of ACC are also different, which we have reported previously [ 19 , 20 ]. While the frequency of germline TP53 mutations in children diagnosed with ACC is notably high, ranging from 50% to 97%, it is significantly lower in adults, at around 5.8% [ 21 ].…”

Development and Interpretation of a Novel Nomogram for the Prognosis of Adult Metastatic Adrenocortical Carcinoma: A Retrospective Cohort Study

“…Our previous studies suggested that the prognosis predictors of ACC were different between children and adult patients, and built different prediction nomogram. Our studies showed that the nomogram incorporating age, tumor size and M stage showed favorable predictive accuracy for overall survival of pediatric (13), and nomogram incorporating age, T, N and M stage predicted the postoperative OS for adult ACC patients (14). Thus, we focused on the adults with mACC patients, and built a nomogram incorporating surgery and chemotherapy with favorable C-index and calibration.…”

Construction and validation of a prognostic model for predicting overall survival of primary adrenal malignant tumor patients: A population-based study with 1,080 patients

“…In contrast, our study is more supportive that gender does not have a significant effect on the prognosis of patients. Unlike the research by Junjiong Zheng et al, we excluded pediatric patients below 15 years old, when including the age variable ( 41 ). This is because pediatric patients may have a different course because of pathology and patients may often be affected by genetic disorders and therefore they show different clinical and prognostic characteristics than the adult population ( 42 , 43 ).…”