Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 24:9:1025213.
doi: 10.3389/fsurg.2022.1025213. eCollection 2022.

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

Wenhao Xie  1 , Yida Zhang  1 , Runfu Cao  1
Affiliations

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

Wenhao Xie et al. Front Surg. .

Abstract

Objective: Primary adrenal malignant tumor is rare. The factors affecting the prognosis remain poorly defined. This study targeted to construct and corroborate a model for predicting the overall survival of adrenal malignant tumor patients.

Methods: We investigated the SEER database for patients with primary adrenal malignant tumor. 1,080 patients were divided into a construction cohort (n = 756) and a validation cohort (n = 324), randomly. The prognostic factors for overall survival were evaluated using univariate and multivariate Cox analyses. The nomogram was constructed and then validated with C-index, calibration curve, time-dependent ROC curve, and decision curve analysis in both cohorts. Then we divided the patients into 3 different risk groups according to the total points of the nomogram and analyzed their survival status by Kaplan-Meier curve with log-rank test.

Results: The baseline characteristics of these two cohorts were not statistically different (P > 0.05). Using univariate and multivariate Cox analyses, 5 variables, including age, tumor size, histological type, tumor stage, and surgery of primary site, were distinguished as prognostic factors (P < 0.05). Based on these variables, we constructed a nomogram to predict the 3- year, 5- year, and 10-year overall survival. The C-indexes were 0.780 (0.760-0.800) in the construction cohort and 0.780 (0.751-0.809) in the validation cohort. In both cohorts, the AUC reached a fairly high level at all time points. The internal and external calibration curves and ROC analysis showed outstanding accuracy and discrimination. The decision curves indicated excellent clinical usefulness. The best cut-off values for the total points of the nomogram were 165.4 and 243.1, and the prognosis was significantly different for the three different risk groups (P < 0.001).

Conclusion: We successfully constructed a model to predict the overall survival of primary adrenal malignant tumor patients. This model was validated to perform brilliantly internally and externally, which can assist us in individualized clinical management.

Keywords: SEER; adrenal malignant tumor; construct; decision curve; nomogram; overall survival; prognosis; validate.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of selection.
Figure 2
Figure 2
Nomogram for predicting 3-year, 5-year and 10-year overall survival of primary adrenal malignant tumor patients in the construction cohort.
Figure 3
Figure 3
Calibration curves at 3-year, 5-year and 10-year points in the construction cohort (A) and in the validation cohort (B).
Figure 4
Figure 4
Decision curve analysis at 3-year point in the construction cohort (A) and in the validation cohort (B).
Figure 5
Figure 5
Time-dependent ROC curves at 3-year, 5-year and 10-year points in the construction cohort (A) and in the validation cohort (B).
Figure 6
Figure 6
The best cut-off values of the total points of the nomogram (A) and Kaplan-Meier curves with log-rank test for the low-risk, middle-risk, and high-risk groups (B).
See this image and copyright information in PMC

References

    1. Terzolo M, Fassnacht M. Endocrine tumours: our experience with the management of patients with non-metastatic adrenocortical carcinoma. Eur J Endocrinol. (2022) 187(3):R27–R40. 10.1530/eje-22-0260 - DOI - PubMed
    1. Mete O, Erickson LA, Juhlin CC, de Krijger RR, Sasano H, Volante M, et al. Overview of the 2022 who classification of adrenal cortical tumors. Endocr Pathol. (2022) 33(1):155–96. 10.1007/s12022-022-09710-8 - DOI - PMC - PubMed
    1. Fassnacht M, Assie G, Baudin E, Eisenhofer G, de la Fouchardiere C, Haak HR, et al. Adrenocortical carcinomas and malignant phaeochromocytomas: esmo-euracan clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. (2020) 31(11):1476–90. 10.1016/j.annonc.2020.08.2099 - DOI - PubMed
    1. Mege D, Taieb D, Lowery A, Loundou A, Micco CDE, Castinetti F, et al. Contemporary review of large adrenal tumors in a tertiary referral center. Anticancer Res. (2014) 34(5):2581–8. - PubMed
    1. Frey S, Caillard C, Toulgoat F, Drui D, Hamy A, Mirallié É. Non-adrenal tumors of the adrenal area; what are the pitfalls? J Visc Surg. (2020) 157(3):217–30. 10.1016/j.jviscsurg.2020.02.004 - DOI - PubMed

LinkOut - more resources