Ge Yuntian, Zhan Yunhong, Pan Chunyu, Li Jia, Li Zhenhua, Bai Song, Liu Lina
Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China.
J Clin Med. 2023 Jan 22;12(3):874. doi: 10.3390/jcm12030874.
(1) Background: Pheochromocytoma is a common cause of secondary hypertension, which is considered curable; nevertheless, some patients still suffer from hypertension after adrenalectomy. Therefore, we developed and validated a nomogram for predicting blood pressure change failure in patients with pheochromocytoma and concomitant hypertension after adrenalectomy. (2) Methods: The development cohort of this study consisted of 259 patients with pheochromocytoma who underwent adrenalectomy at our center between 1 January 2007 and 31 December 2018. Each patient's clinicopathologic data were recorded. LASSO (the least absolute shrinkage and selection operator) regression was used to reduce and select the features of the data. Furthermore, we used multivariate logistic regression analysis to develop the prediction model. An independent cohort of 110 consecutive patients from 1 January 2019 to 31 December 2021 was used for validation. The performance of this nomogram was assessed with regard to discrimination, calibration, and clinical usefulness. (3) Results: 40.9% and 46.4% of patients experienced blood pressure change failure in the development and validation cohorts of this study, respectively. We found that older patients with a longer duration of hypertension and concomitant cardiovascular events were more likely to suffer from blood pressure change failure. In the validation cohort, the model manifested great discrimination with an AUROC (area under the receiver operating characteristic) of 0.996 ( < 0.001) and good calibration (unreliability test, = 0.359). Decision curve analysis demonstrated that the model was clinically useful. (4) Conclusions: This study presented a reliable nomogram that facilitated individualized preoperative prediction of blood pressure change failure after adrenalectomy in patients with pheochromocytoma, which may help decision-making in perioperative treatment and follow-up strategies.
(1) 背景：嗜铬细胞瘤是继发性高血压的常见病因，被认为是可治愈的；然而，一些患者在肾上腺切除术后仍患有高血压。因此，我们开发并验证了一种列线图，用于预测嗜铬细胞瘤合并高血压患者肾上腺切除术后血压变化失败的情况。(2) 方法：本研究的开发队列包括259例于2007年1月1日至2018年12月31日在我们中心接受肾上腺切除术的嗜铬细胞瘤患者。记录每位患者的临床病理数据。使用LASSO（最小绝对收缩和选择算子）回归来减少和选择数据特征。此外，我们使用多因素逻辑回归分析来建立预测模型。来自2019年1月1日至2021年12月31日的110例连续患者的独立队列用于验证。从区分度、校准度和临床实用性方面评估该列线图的性能。(3) 结果：在本研究的开发队列和验证队列中，分别有40.9%和46.4%的患者出现血压变化失败。我们发现年龄较大、高血压病程较长且伴有心血管事件的患者更有可能出现血压变化失败。在验证队列中，该模型表现出良好的区分度，受试者操作特征曲线下面积（AUROC）为0.996（<0.001），校准度良好（不可靠性检验，P = 0.359）。决策曲线分析表明该模型具有临床实用性。(4) 结论：本研究提出了一种可靠的列线图，有助于对嗜铬细胞瘤患者肾上腺切除术后血压变化失败进行个体化术前预测，这可能有助于围手术期治疗决策和后续随访策略。
