Top

International Urology and Nephrology

Published in:

01-06-2020 | Adrenocortical Carcinoma | Urology - Original Paper

Development and validation of prognostic nomograms in patients with adrenocortical carcinoma: a population-based study

Authors: Hao Zhang, Yaser Naji, Minbo Yan, Wenfei Lian, Maochun Xie, Yingbo Dai

Published in: International Urology and Nephrology | Issue 6/2020

Abstract

Background

Predicting the prognosis of patients with adrenocortical carcinoma (ACC) is difficult, due to its unpredictable behavior. The aim of this study is to develop and validate a nomogram to predict survival outcomes in patients with ACC.

Methods

Nomograms were established using the data collected from the Surveillance, Epidemiology, and End Results (SEER) database. Based on univariate and multivariate Cox regression analyses, we identified independent risk factors for overall survival (OS) and cancer-specific survival (CSS). Concordance indexes (c-indexes), the area under the receiver operating characteristics curve (AUC) and calibration curve were used to evaluate predictive performance of these models. The clinical use of nomogram was measured by decision curve analysis (DCA) and clinical impact curves.

Results

A total of 855 eligible patients, randomly divided into training (n = 600) and validation cohorts (n = 255), were included in this study. Based on the independent predictors, the nomograms were established and demonstrated good discriminative abilities, with C-indexes for OS and CSS were 0.762 and 0.765 in training cohorts and 0.738 and 0.758 in validation cohorts, respectively. The AUC and calibration plots also demonstrated a good performance for both nomograms. DCA indicated that the two nomograms provide clinical net benefits.

Conclusion

We unveiled the prognostic factors of ACC and developed novel nomograms that predict OS and CSS more accurately and comprehensively, which can help clinicians improve individual treatment, making proper clinical decisions and adjusting follow-up management strategies.

Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A (2006) Extent of disease at presentation and outcome for adrenocortical carcinoma: Have we made progress? World J Surg 30(5):872–878. https://doi.org/10.1007/s00268-005-0329-x CrossRefPubMed

Fassnacht M, Kroiss M, Allolio B (2013) Update in adrenocortical carcinoma. J Clin Endocrinol Metab 98(12):4551–4564. https://doi.org/10.1210/jc.2013-3020 CrossRefPubMed

Icard P, Goudet P, Charpenay C et al (2001) Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons Study Group. World J Surg 25(7):891–897. https://doi.org/10.1007/s00268-001-0047-y CrossRefPubMed

Ayala-Ramirez M, Jasim S, Feng L et al (2013) Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center. Eur J Endocrinol 169(6):891–899. https://doi.org/10.1530/EJE-13-0519 CrossRefPubMedPubMedCentral

Sharma E, Dahal S, Sharma P et al (2018) The characteristics and trends in adrenocortical carcinoma: a United States Population Based Study. J Clin Med Res 10(8):636–640. https://doi.org/10.14740/jocmr3503w CrossRefPubMedPubMedCentral

Allolio B, Hahner S, Weismann D, Fassnacht M (2004) Management of adrenocortical carcinoma. Clin Endocrinol (Oxf) 60(3):273–287. https://doi.org/10.1046/j.1365-2265.2003.01881.x CrossRef

Zini L, Capitanio U, Jeldres C et al (2009) External validation of a nomogram predicting mortality in patients with adrenocortical carcinoma. BJU Int 104(11):1661–1667. https://doi.org/10.1111/j.1464-410X.2009.08660.x CrossRefPubMed

Li Y, Bian X, Ouyang J, Wei S, He M, Luo Z (2018) Nomograms to predict overall survival and cancer-specific survival in patients with adrenocortical carcinoma. Cancer Manag Res 10:6949–6959. https://doi.org/10.2147/CMAR.S187169 CrossRefPubMedPubMedCentral

Cronin KA, Ries LAG, Edwards BK (2014) Preface. Cancer 120(S23):3755–3757. https://doi.org/10.1002/cncr.29049 CrossRefPubMed

10.

Camp RL, Dolled-Filhart M, Rimm DL (2004) X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res 10(21):7252–7259. https://doi.org/10.1158/1078-0432.CCR-04-0713 CrossRefPubMed

11.

DeLellis RA, Lloyd RV, Heitz PU, Eng C (eds) (2004) Pathology and genetics of tumours of endocrine organs. IARC, Lyon

12.

Moons KG, Altman DG, Reitsma JB et al (2015) Transparent reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 162:W1–W73. https://doi.org/10.7326/M14-0698 CrossRefPubMed

13.

Sauerbrei W, Boulesteix AL, Binder H (2011) Stability investigations of multivariable regression models derived from low- and high-dimensional data. J Biopharm Stat 21(6):1206–1231. https://doi.org/10.1080/10543406.2011.629890 CrossRefPubMed

14.

Royston P, Altman DG (2013) External validation of a Cox prognostic model: Principles and methods. BMC Med Res Methodol. https://doi.org/10.1186/1471-2288-13-33 CrossRefPubMedPubMedCentral

15.

Vickers AJ, Cronin AM, Elkin EB, Gonen M (2008) Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inform Decis Mak 8:1–17. https://doi.org/10.1186/1472-6947-8-53 CrossRef

16.

Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 26(6):565–574. https://doi.org/10.1177/0272989X06295361 CrossRefPubMedPubMedCentral

17.

Huang YQ, Liang CH, He L et al (2016) Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol 34(18):2157–2164. https://doi.org/10.1200/JCO.2015.65.9128 CrossRefPubMed

18.

Bilimoria KY, Shen WT, Elaraj D et al (2008) Adrenocortical carcinoma in the United States: treatment utilization and prognostic factors. Cancer 113(11):3130–3136. https://doi.org/10.1002/cncr.23886 CrossRefPubMed

19.

Stojadinovic A, Ghossein RA, Hoos A et al (2002) Adrenocortical carcinoma: clinical, morphologic, and molecular characterization. J Clin Oncol 20(4):941–950. https://doi.org/10.1200/JCO.2002.20.4.941 CrossRefPubMed

20.

Harrison LE, Gaudin PB, Brennan MF (1999) Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection. Arch Surg 134(2):181–185. https://doi.org/10.1001/archsurg.134.2.181 CrossRefPubMed

21.

Şişman P, Şahin AB, Peynirci H et al (2017) Adrenokortikal karsinom: Tek merkez deneyimi. Turkish J Urol 43(4):462–469. https://doi.org/10.5152/tud.2017.81598 CrossRef

22.

Wang S, Chen S-S, Gao W-C et al (2017) Prognostic factors of adrenocortical carcinoma: an analysis of the Surveillance Epidemiology and End Results (SEER) database. Asian Pac J Cancer Prev 18(10):2817–2823. https://doi.org/10.22034/APJCP.2017.18.10.2817 CrossRefPubMedPubMedCentral

23.

Paton BL, Novitsky YW, Zerey M et al (2006) Outcomes of adrenal cortical carcinoma in the United States. Surgery 140(6):914–920. https://doi.org/10.1016/j.surg.2006.07.035 CrossRefPubMed

24.

Vaidya A, Nehs M, Kilbridge K (2019) Treatment of adrenocortical carcinoma. Surg Pathol Clin 12(4):997–1006. https://doi.org/10.1016/j.path.2019.08.010 CrossRefPubMed

25.

Sabolch A, Feng M, Griffith K, Hammer G, Doherty G, Ben-Josef E (2011) Adjuvant and definitive radiotherapy for adrenocortical carcinoma. Int J Radiat Oncol Biol Phys 80(5):1477–1484. https://doi.org/10.1016/j.ijrobp.2010.04.030 CrossRefPubMed

26.

Fassnacht M, Hahner S, Polat B et al (2006) Efficacy of adjuvant radiotherapy of the tumor bed on local recurrence of adrenocortical carcinoma. J Clin Endocrinol Metab 91(11):4501–4504. https://doi.org/10.1210/jc.2006-1007 CrossRefPubMed

27.

Hescot S, Slama A, Lombes A et al (2013) Mitotane alters mitochondrial respiratory chain activity by inducing cytochrome c oxidase defect in human adrenocortical cells. Endocr Relat Cancer 20(3):371–381. https://doi.org/10.1530/ERC-12-0368 CrossRefPubMed

28.

Fitzgerald M, Saville BR, Lewis RJ (2015) Decision curve analysis. JAMA 313(4):409–410. https://doi.org/10.1001/jama.2015.37 CrossRefPubMed

29.

Kerr KF, Brown MD, Zhu K, Janes H (2016) Assessing the clinical impact of risk prediction models with decision curves: guidance for correct interpretation and appropriate use. J Clin Oncol 34(21):2534–2540. https://doi.org/10.1200/JCO.2015.65.5654 CrossRefPubMedPubMedCentral

30.

Fassnacht M, Johanssen S, Quinkler M et al (2009) Limited prognostic value of the 2004 international union against cancer staging classification for adrenocortical carcinoma. Cancer 115(2):243–250. https://doi.org/10.1002/cncr.24030 CrossRefPubMed

31.

Gaujoux S, Grabar S, Fassnacht M et al (2011) Β-catenin activation is associated with specific clinical and pathologic characteristics and a poor outcome in adrenocortical carcinoma. Clin Cancer Res 17(2):328–336. https://doi.org/10.1158/1078-0432.CCR-10-2006 CrossRefPubMed

Title: Development and validation of prognostic nomograms in patients with adrenocortical carcinoma: a population-based study
Authors: Hao Zhang
Yaser Naji
Minbo Yan
Wenfei Lian
Maochun Xie
Yingbo Dai
Publication date: 01-06-2020
Publisher: Springer Netherlands
Keyword: Adrenocortical Carcinoma
Published in: International Urology and Nephrology / Issue 6/2020
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-020-02413-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

A unifying model of glucotoxicity in human renal proximal tubular epithelial cells and the effect of the SGLT2 inhibitor dapagliflozin

Association between albumin-to-globulin ratio and long-term mortality in patients with chronic kidney disease: a cohort study

Kidney biopsy in patients after liver transplantation: an underutilized, but clinically important procedure

Do rapid emotional thermometers correlate with multidimensional validated structured questionnaires in low-risk prostate cancer?

Risk factors for decreased upper-limb muscle strength and its impact on survival in maintenance hemodialysis patients

Gender effect on the oncologic outcomes of upper urinary tract urothelial carcinoma in Taiwan

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials