Serviço de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 155, Sao Paulo, Brazil.
Clin Endocrinol (Oxf). 2013 Oct;79(4):468-75. doi: 10.1111/cen.12174. Epub 2013 Mar 27.
To develop and internally validate a prognostic score to predict the risk of metastases or recurrence in patients with adrenal cortical carcinomas (ACC).
Clinical, laboratory and pathological data from 129 ACC patients, treated in a tertiary centre, were retrospectively reviewed.
Using a multivariate binary logistic regression analysis, we developed a prognostic score with five covariates: a functional pattern other than isolated hyperandrogenism, a tumour size >7·5 cm, a primary tumour classified as T3/T4, the presence of microscopic venous invasion and a mitotic index >5/50 high-power fields. The prognostic score was calibrated according to the Hosmer-Lemeshow goodness-of-fit test (P = 0·9329) and exhibited excellent overall performance (Brier score = 0·0738). Finally, the discriminatory ability of the model, determined by the area under the ROC curve (AROC ), was near perfect (AROC , 0·9611; 95% CI, 0·92676-0·99552). The prediction model was internally validated with 200 bootstrap resamples and achieved excellent performance for estimating the risk of metastasis and recurrence in eight additional patients with apparently localized disease at diagnosis.
We developed and internally validated a prognostic score based on the clinicopathological data that are readily available to any attending physician. Our model can be used to accurately estimate the risk of unfavourable outcomes in ACC patients. This score could be beneficial for both patient counselling and the identification of patients in whom adjuvant mitotane is justified.
开发并内部验证一种预测肾上腺皮质癌（ACC）患者转移或复发风险的预后评分。
回顾性分析了 129 名在三级中心接受治疗的 ACC 患者的临床、实验室和病理数据。
使用多变量二项逻辑回归分析，我们开发了一个预后评分，包含五个协变量：除孤立性高雄激素血症以外的功能模式、肿瘤大小＞7.5cm、原发性肿瘤分类为 T3/T4、存在镜下静脉侵犯和有丝分裂指数＞5/50 高倍视野。预后评分根据 Hosmer-Lemeshow 拟合优度检验进行校准（P=0.9329），并表现出优异的整体性能（Brier 评分=0.0738）。最后，通过 ROC 曲线下面积（AROC）确定的模型判别能力接近完美（AROC，0.9611；95%CI，0.92676-0.99552）。该预测模型通过 200 次 bootstrap 重采样进行了内部验证，在另外 8 名诊断时表现为局部疾病的患者中，对转移和复发风险的估计也表现出优异的性能。
我们基于任何主治医生都能轻易获得的临床病理数据开发并内部验证了一种预后评分。我们的模型可用于准确估计 ACC 患者不良预后的风险。该评分可能对患者咨询和识别需要接受辅助米托坦治疗的患者均有益。
