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Journal of Endocrinological Investigation

Erschienen in:

11.01.2024 | Original Article

Novel alternative tools for metastatic pheochromocytomas/paragangliomas prediction

verfasst von: Y. Cui, Y. Zhou, Y. Gao, X. Ma, Y. Wang, X. Zhang, T. Zhou, S. Chen, L. Lu, Y. Zhang, X. Chang, A. Tong, Y. Li

Erschienen in: Journal of Endocrinological Investigation | Ausgabe 5/2024

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Abstract

Objective

The existing prediction models for metastasis in pheochromocytomas/paragangliomas (PPGLs) showed high heterogeneity in different centers. Therefore, this study aimed to establish new prediction models integrating multiple variables based on different algorithms.

Design and methods

Data of patients with PPGLs undergoing surgical resection at the Peking Union Medical College Hospital from 2007 to 2022 were collected retrospectively. Patients were randomly divided into the training and testing sets in a ratio of 7:3. Subsequently, decision trees, random forest, and logistic models were constructed for metastasis prediction with the training set and Cox models for metastasis-free survival (MFS) prediction with the total population. Additionally, Ki-67 index and tumor size were transformed into categorical variables for adjusting models. The testing set was used to assess the discrimination and calibration of models and the optimal models were visualized as nomograms. Clinical characteristics and MFS were compared between patients with and without risk factors.

Results

A total of 198 patients with 59 cases of metastasis were included and classified into the training set (n = 138) and testing set (n = 60). Among all models, the logistic regression model showed the best discrimination for metastasis prediction with an AUC of 0.891 (95% CI, 0.793–0.990), integrating SDHB germline mutations [OR: 96.72 (95% CI, 16.61–940.79)], S-100 (-) [OR: 11.22 (95% CI, 3.04–58.51)], ATRX (-) [OR: 8.42 (95% CI, 2.73–29.24)] and Ki-67 ≥ 3% [OR: 7.98 (95% CI, 2.27–32.24)] evaluated through immunohistochemistry (IHC), and tumor size ≥ 5 cm [OR: 4.59 (95% CI, 1.34–19.13)]. The multivariate Cox model including the above risk factors also showed a high C-index of 0.860 (95% CI, 0.810–0.911) in predicting MFS after surgery. Furthermore, patients with the above risk factors showed a significantly poorer MFS (P ≤ 0.001).

Conclusions

Models established in this study provided alternative and reliable tools for clinicians to predict PPGLs patients’ metastasis and MFS. More importantly, this study revealed for the first time that IHC of ATRX could act as an independent predictor of metastasis in PPGLs.

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Titel: Novel alternative tools for metastatic pheochromocytomas/paragangliomas prediction
verfasst von: Y. Cui
Y. Zhou
Y. Gao
X. Ma
Y. Wang
X. Zhang
T. Zhou
S. Chen
L. Lu
Y. Zhang
X. Chang
A. Tong
Y. Li
Publikationsdatum: 11.01.2024
Verlag: Springer International Publishing
Erschienen in: Journal of Endocrinological Investigation / Ausgabe 5/2024
Elektronische ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-023-02239-5

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Novel alternative tools for metastatic pheochromocytomas/paragangliomas prediction