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

ABSTRACT: 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.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.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.The discriminative ability and calibration of the nomograms to predict RFS and OS were tested using C statistics, calibration plots, and Kaplan-Meier curves.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

SUBMITTER: Kim Y

PROVIDER: S-EPMC4967352 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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

Kim Yuhree Y Margonis Georgios A GA Prescott Jason D JD Tran Thuy B TB Postlewait Lauren M LM Maithel Shishir K SK Wang Tracy S TS Evans Douglas B DB Hatzaras Ioannis I Shenoy Rivfka R Phay John E JE Keplinger Kara K Fields Ryan C RC Jin Linda X LX Weber Sharon M SM Salem Ahmed I AI Sicklick Jason K JK Gad Shady S Yopp Adam C AC Mansour John C JC Duh Quan-Yang QY Seiser Natalie N Solorzano Carmen C CC Kiernan Colleen M CM Votanopoulos Konstantinos I KI Levine Edward A EA Poultsides George A GA Pawlik Timothy M TM

JAMA surgery 20160401 4

<h4>Importance</h4>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.<h4>Objectives</h4>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.<h4>Design, setting, and participants</h4>Nomograms to predict RFS and ...[more]

PMID: 26676603

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Project description:Background Serpin peptidase inhibitor, clade E, member 1 (SERPINE1) has been investigated as an oncogene and potential biomarker in several cancers, including gastric cancer (GC). This study aimed to investigate SERPINE1 expression and its diagnostic and prognostic value by analyzing data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Methods A meta-analysis was performed to investigate SERPINE1 expression levels in GC tissues and adjacent normal tissues. Gene set enrichment, multi experiment matrix (MEM), and protein-protein interaction (PPI) network analyses were performed to identify the most enriched signaling pathways and SERPINE1-related module genes. A Cox regression model was used to develop a nomogram that was able to predict the overall survival (OS) and recurrence-free survival (RFS) of individual patients. Results Meta-analyses revealed an elevated trend in SERPINE1 expression levels in TCGA [standard mean difference (SMD) =0.95; 95% confidence interval (CI), 0.53–1.36; P<0.001]. The diagnostic meta-analysis results indicated that the area under the curve (AUC) of the summary receiver operating characteristic (SROC) was 0.80 (95% CI, 0.77–0.84). The factors identified to predict OS were age ≥60 years [hazard ratio (HR), 2.14; 95% CI, 1.45–3.16; P<0.01], R2 margins (HR, 2.70; 95% CI, 1.41–5.14; P<0.05), lymph node-positive proportion (HR, 3.38; 95% CI, 2.03–5.63; P<0.001), patient tumor status (HR, 3.33; 95% CI, 2.28–4.87; P<0.001), and OS risk score (HR, 2.72; 95% CI, 1.82–4.05; P<0.05). The following variables were associated with RFS: male sex (HR, 2.55; 95% CI, 1.46–4.45; P<0.01), R2 margins (HR, 13.08; 95% CI, 4.26–40.15; P<0.001), lymph node-positive proportion (HR, 2.55; 95% CI, 1.20–5.45; P<0.05), and RFS risk score (HR, 2.70; 95% CI, 1.82–4.06; P<0.001). The discriminative ability of the final model for OS and RFS was assessed using C statistics (0.755 for OS and 0.745 for RFS). Conclusions SERPINE1 was upregulated in GC, showed a high diagnostic value, and was associated with poorer OS and RFS. The OS and RFS risk for an individual patient could be estimated using these nomograms, which could lead to individualized therapeutic choices.

Project description:BackgroundFew studies have focused on the prognosis of patients with hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage 0‒C in terms of early recurrence and 5-years overall survival (OS). We sought to develop nomograms for predicting 5-year OS and early recurrence after curative resection of HCC, based on a clinicopathological‒radiological model. We also investigated whether different treatment methods influenced the OS of patients with early recurrence.MethodsRetrospective data, including clinical pathology, radiology, and follow-up data, were collected for 494 patients with HCC who underwent hepatectomy. Nomograms estimating OS and early recurrence were constructed using multivariate Cox regression analysis, based on the random survival forest (RSF) model. We evaluated the discrimination and calibration abilities of the nomograms using concordance indices (C-index), calibration curves, and Kaplan‒Meier curves. OS curves of different treatments for patients who had recurrence within 2 years after curative surgery were depicted and compared using the Kaplan-Meier method and the log-rank test.ResultsMultivariate Cox regression revealed that BCLC stage, non-smooth margin, maximum tumor diameter, age, aspartate aminotransferase levels, microvascular invasion, and differentiation were prognostic factors for OS and were incorporated into the nomogram with good predictive performance in the training (C-index: 0.787) and testing cohorts (C-index: 0.711). A nomogram for recurrence-free survival was also developed based on four prognostic factors (BCLC stage, non-smooth margin, maximum tumor diameter, and microvascular invasion) with good predictive performance in the training (C-index: 0.717) and testing cohorts (C-index: 0.701). In comparison to the BCLC staging system, the C-index (training cohort: 0.787 vs. 0.678, 0.717 vs. 0.675; external cohort 2: 0.748 vs. 0.624, 0.729 vs. 0.587 respectively, for OS and RFS; external cohort1:0.716 vs. 0.627 for RFS, all p value<0.05), and model calibration curves all showed improved performance. Patients who underwent surgery after tumor recurrence had a higher reOS than those who underwent comprehensive treatments and supportive care.ConclusionsThe nomogram, based on clinical, pathological, and radiological factors, demonstrated good accuracy in estimating OS and recurrence, which can guide follow-up and treatment of individual patients. Reoperation may be the best option for patients with recurrence in good condition.

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Dataset Information

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

Publications

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

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