Nomograms to Predict Recurrence-Free and Overall Survival After Curative Resection of Adrenocortical Carcinoma

Abstract

IMPORTANCE Adrenocortical carcinoma (ACC) is a rare but aggressive endocrine tumor, and the prognostic factors associated with long-term outcomes after surgical resection remain poorly defined. OBJECTIVES To define clinicopathological variables associated with recurrence-free survival (RFS) and overall survival (OS) after curative surgical resection of ACC and to propose nomograms for individual risk prediction. DESIGN, SETTING, AND PARTICIPANTS Nomograms to predict RFS and OS after surgical resection of ACC were proposed using a multi-institutional cohort of patients who underwent curative-intent surgery for ACC at 13 major institutions in the United States between March 17, 1994, and December 22, 2014. The dates of our study analysis were April 15, 2015, to May 12, 2015. MAIN OUTCOMES AND MEASURES The discriminative ability and calibration of the nomograms to predict RFS and OS were tested using C statistics, calibration plots, and Kaplan-Meier curves. RESULTS In total, 148 patients who underwent surgery for ACC were included in the study. The median patient age was 53 years, and 65.5% (97 of 148) of the patients were female. One-third of the patients (35.1% [52 of 148]) had a functional tumor, and the median tumor size was 11.2 cm. Most patients (77.7% [115 of 148]) underwent R0 resection, and 8.8% (13 of 148) of the patients had N1 disease. Using backward stepwise selection of clinically important variables with the Akaike information criterion, the following variables were incorporated in the prediction of RFS: tumor size of at least 12 cm (hazard ratio [HR], 3.00; 95% CI, 1.63–5.70; P < .001), positive nodal status (HR, 4.78; 95% CI, 1.47–15.50; P = .01), stage III/IV (HR, 1.80; 95% CI, 0.95–3.39; P = .07), cortisol-secreting tumor (HR, 2.38; 95% CI, 1.27–4.48; P = .01), and capsular invasion (HR, 1.96; 95% CI, 1.02–3.74; P = .04). Factors selected as predicting OS were tumor size of at least 12 cm (HR, 1.78; 95% CI, 1.00–3.17; P = .05), positive nodal status (HR, 5.89; 95% CI, 2.05–16.87; P = .001), and R1 margin (HR, 2.83; 95% CI, 1.51–5.30; P = .001). The discriminative ability and calibration of the nomograms revealed good predictive ability as indicated by the C statistics (0.74 for RFS and 0.70 for OS). CONCLUSIONS AND RELEVANCE Independent predictors of survival and recurrence risk after curative-intent surgery for ACC were selected to create nomograms predicting RFS and OS. The nomograms were able to stratify patients into prognostic groups and performed well on internal validation.

Perioperative risk calculator for distal gastrectomy predicts overall survival in patients with gastric cancer

“…We also suggested the reliability of a risk calculator for the prediction of DFS and CSS. Many studies have indicated that a scoring system or nomogram predicts long-term survival after a gastectomy [2][3][4][5]18], and they did so by identifying postoperative clinicopathological factors. Only a few studies have evaluated preoperative prognostic factors for predicting long-term outcomes in patients with gastric cancer, such as the Modified Glasgow Prognostic Score, C-reactive protein-to-albumin ratio, blood neutrophil-to-lymphocyte ratio, lymphocyte-tomonocyte ratio, albumin-to-globulin ratio, and combination of hemoglobin, albumin, lymphocytes, and platelets [19][20][21][22][23][24].…”

“…Therefore, the prediction of long-term outcomes preoperatively is required for each patient. Some predictive factors of long-term prognosis after a gastrectomy have been reported [2][3][4][5]; however, only few studies have predicted long-term outcomes based on preoperative parameters.…”

Current Management of Adrenal Incidentalomas

“…The authors also showed that adrenocortical carcinoma (ACC) was more common in younger patients compared to those patients with benign adenomas (median age 46 years versus 57 years). Due to the aggressive nature and rapid growth rate of ACC, and since achieving free margins is one of the most important determinants in extending patient survival [6,7], current guidelines suggest adrenalectomy in all surgically it patients with an adrenal mass >4 cm [8,9]. lipid concentration and low density.…”

Nomogram to predict survival of patients with advanced and metastatic pancreatic cancer

“…Nomogram could evaluate the survival probability of patients with the speci c scoring system [13,14]. And nomograms have been used in different cancers for predicting survival rate [15,16]. Few studies used the nomograms to predict the survival rate of patients with advanced or metastatic PC [17,18].…”