Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma

Yuhree Kim, Georgios A. Margonis, Jason D. Prescott, Thuy B. Tran, Lauren M. Postlewait, Shishir K. Maithel, Tracy S. Wang, Douglas B. Evans, Ioannis Hatzaras, Rivfka Shenoy, John E. Phay, Kara Keplinger, Ryan C. Fields, Linda X. Jin, Sharon M. Weber, Ahmed I. Salem, Jason K. Sicklick, Shady Gad, Adam C. Yopp, John C. Mansour & 8 others Quan Yang Duh, Natalie Seiser, Carmen C. Solorzano, Colleen M. Kiernan, Konstantinos I. Votanopoulos, Edward A. Levine, George A. Poultsides, Timothy M. Pawlik

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)365-373
Number of pages9
JournalJAMA Surgery
Volume151
Issue number4
DOIs
StatePublished - Apr 1 2016

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Adrenocortical Carcinoma
Nomograms
Recurrence
Survival
Calibration
Neoplasms

ASJC Scopus subject areas

  • Surgery

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Kim, Y., Margonis, G. A., Prescott, J. D., Tran, T. B., Postlewait, L. M., Maithel, S. K., ... Pawlik, T. M. (2016). Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma. JAMA Surgery, 151(4), 365-373. https://doi.org/10.1001/jamasurg.2015.4516

Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma. / Kim, Yuhree; Margonis, Georgios A.; Prescott, Jason D.; Tran, Thuy B.; Postlewait, Lauren M.; Maithel, Shishir K.; Wang, Tracy S.; Evans, Douglas B.; Hatzaras, Ioannis; Shenoy, Rivfka; Phay, John E.; Keplinger, Kara; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed I.; Sicklick, Jason K.; Gad, Shady; Yopp, Adam C.; Mansour, John C.; Duh, Quan Yang; Seiser, Natalie; Solorzano, Carmen C.; Kiernan, Colleen M.; Votanopoulos, Konstantinos I.; Levine, Edward A.; Poultsides, George A.; Pawlik, Timothy M.

In: JAMA Surgery, Vol. 151, No. 4, 01.04.2016, p. 365-373.

Research output: Contribution to journalArticle

Kim, Y, Margonis, GA, Prescott, JD, Tran, TB, Postlewait, LM, Maithel, SK, Wang, TS, Evans, DB, Hatzaras, I, Shenoy, R, Phay, JE, Keplinger, K, Fields, RC, Jin, LX, Weber, SM, Salem, AI, Sicklick, JK, Gad, S, Yopp, AC, Mansour, JC, Duh, QY, Seiser, N, Solorzano, CC, Kiernan, CM, Votanopoulos, KI, Levine, EA, Poultsides, GA & Pawlik, TM 2016, 'Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma', JAMA Surgery, vol. 151, no. 4, pp. 365-373. https://doi.org/10.1001/jamasurg.2015.4516
Kim, Yuhree ; Margonis, Georgios A. ; Prescott, Jason D. ; Tran, Thuy B. ; Postlewait, Lauren M. ; Maithel, Shishir K. ; Wang, Tracy S. ; Evans, Douglas B. ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Phay, John E. ; Keplinger, Kara ; Fields, Ryan C. ; Jin, Linda X. ; Weber, Sharon M. ; Salem, Ahmed I. ; Sicklick, Jason K. ; Gad, Shady ; Yopp, Adam C. ; Mansour, John C. ; Duh, Quan Yang ; Seiser, Natalie ; Solorzano, Carmen C. ; Kiernan, Colleen M. ; Votanopoulos, Konstantinos I. ; Levine, Edward A. ; Poultsides, George A. ; Pawlik, Timothy M. / Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma. In: JAMA Surgery. 2016 ; Vol. 151, No. 4. pp. 365-373.
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title = "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.",
author = "Yuhree Kim and Margonis, {Georgios A.} and Prescott, {Jason D.} and Tran, {Thuy B.} and Postlewait, {Lauren M.} and Maithel, {Shishir K.} and Wang, {Tracy S.} and Evans, {Douglas B.} and Ioannis Hatzaras and Rivfka Shenoy and Phay, {John E.} and Kara Keplinger and Fields, {Ryan C.} and Jin, {Linda X.} and Weber, {Sharon M.} and Salem, {Ahmed I.} and Sicklick, {Jason K.} and Shady Gad and Yopp, {Adam C.} and Mansour, {John C.} and Duh, {Quan Yang} and Natalie Seiser and Solorzano, {Carmen C.} and Kiernan, {Colleen M.} and Votanopoulos, {Konstantinos I.} and Levine, {Edward A.} and Poultsides, {George A.} and Pawlik, {Timothy M.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1001/jamasurg.2015.4516",
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pages = "365--373",
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TY - JOUR

T1 - Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma

AU - Kim, Yuhree

AU - Margonis, Georgios A.

AU - Prescott, Jason D.

AU - Tran, Thuy B.

AU - Postlewait, Lauren M.

AU - Maithel, Shishir K.

AU - Wang, Tracy S.

AU - Evans, Douglas B.

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Phay, John E.

AU - Keplinger, Kara

AU - Fields, Ryan C.

AU - Jin, Linda X.

AU - Weber, Sharon M.

AU - Salem, Ahmed I.

AU - Sicklick, Jason K.

AU - Gad, Shady

AU - Yopp, Adam C.

AU - Mansour, John C.

AU - Duh, Quan Yang

AU - Seiser, Natalie

AU - Solorzano, Carmen C.

AU - Kiernan, Colleen M.

AU - Votanopoulos, Konstantinos I.

AU - Levine, Edward A.

AU - Poultsides, George A.

AU - Pawlik, Timothy M.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

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