title: External validation of a nomogram predicting mortality in patients with adrenocortical carcinoma.
abstract: OBJECTIVE
  To develop nomograms predicting cancer-specific and all-cause mortality in patients managed with either surgery or no surgery for adrenocortical carcinoma (ACC).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zini
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Claudio
authors.initials: C
authors.lastname: Jeldres
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Philippe
authors.initials: P
authors.lastname: Arjane
authors.forename: Hugues
authors.initials: H
authors.lastname: Widmer
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000401:mortality*; D018268:Adrenocortical Carcinoma / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D055815:Young Adult