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External validation of a nomogram predicting mortality in patients with adrenocortical carcinoma

  1. Laurent Zini1,2,
  2. Umberto Capitanio1,4,
  3. Claudio Jeldres1,
  4. Giovanni Lughezzani1,4,
  5. Maxine Sun1,
  6. Shahrokh F. Shariat1,
  7. Hendrik Isbarn5,
  8. Philippe Arjane3,
  9. Hugues Widmer3,
  10. Paul Perrotte3,
  11. Markus Graefen5,
  12. Francesco Montorsi4,
  13. Pierre I. Karakiewicz1,3,*

Article first published online: 2 JUN 2009

DOI: 10.1111/j.1464-410X.2009.08660.x

Issue

BJU International

BJU International

Volume 104, Issue 11, pages 1661–1667, December 2009

Additional Information

How to Cite

Zini, L., Capitanio, U., Jeldres, C., Lughezzani, G., Sun, M., Shariat, S. F., Isbarn, H., Arjane, P., Widmer, H., Perrotte, P., Graefen, M., Montorsi, F. and Karakiewicz, P. I. (2009), External validation of a nomogram predicting mortality in patients with adrenocortical carcinoma. BJU International, 104: 1661–1667. doi: 10.1111/j.1464-410X.2009.08660.x

Author Information

  1. 1

    Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada, and Departments of Urology,

  2. 2

    Lille University Hospital, Lille, France,

  3. 3

    University of Montreal, Montreal, Canada,

  4. 4

    Vita-Salute San Raffaele, Milan, Italy and

  5. 5

    Martini Clinic, Hamburg, Germany

*Pierre I. Karakiewicz, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center (CHUM), 1058 rue St-Denis, Montreal, Quebec, Canada, H2X 3J4. e-mail: pierre.karakiewicz@umontreal.ca

Publication History

  1. Issue published online: 10 NOV 2009
  2. Article first published online: 2 JUN 2009
  3. Accepted for publication 18 March 2009

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Keywords:

  • adrenocortical carcinoma;
  • nomogram;
  • cancer-specific mortality;
  • all-cause mortality;
  • natural history

OBJECTIVE

To develop nomograms predicting cancer-specific and all-cause mortality in patients managed with either surgery or no surgery for adrenocortical carcinoma (ACC).

PATIENTS AND METHODS

The models were developed in 205 patients with ACC and externally validated using 207 other patients with ACC, identified in the 1973–2004 Surveillance, Epidemiology and End Results database. The predictors comprised age, gender, race, stage and surgery status. Nomograms based on Cox regression model-derived coefficients were used for predicting the cancer-specific and all-cause mortality, and were tested using area under the receiver operating characteristics (ROC) curve.

RESULTS

In cancer-specific analyses, the median survival of patients within the development cohort was 26 months, vs 71 months in the external validation cohort (P < 0.001). In overall survival analyses, the median values were 21 vs 32 months for, respectively, the development and the external validation cohort (P < 0.001). Three variables (age, stage and surgical status) were included in the nomograms predicting cancer-specific and all-cause mortality. In the external validation cohort, the nomograms achieved between 72 and 80% accuracy for prediction of cancer-specific or all-cause mortality at 1–5 years after either surgery or diagnosis of ACC for non-surgical patients.

CONCLUSION

Our models are the first standardized and individualized prognostic tools for patients with ACC. Their accuracy was confirmed within a large external population-based cohort of patients with ACC.

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