title: Development and internal validation of an adrenal cortical carcinoma prognostic score for predicting the risk of metastasis and local recurrence.
abstract: OBJECTIVE
  To develop and internally validate a prognostic score to predict the risk of metastases or recurrence in patients with adrenal cortical carcinomas (ACC).
  
  
  METHODS
  Clinical, laboratory and pathological data from 129 ACC patients, treated in a tertiary centre, were retrospectively reviewed.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Serviço de Endocrinologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 155, Sao Paulo, Brazil. dsfreire@terra.com.br
authors: Daniel Soares
authors: DS
authors: Freire
authors: Sheila Aparecida Coelho
authors: SA
authors: Siqueira
authors: Maria Cláudia Nogueira
authors: MC
authors: Zerbini
authors: Bernardo Léo
authors: BL
authors: Wajchenberg
authors: Maria Lúcia
authors: ML
authors: Corrêa-Giannella
authors: Antônio Marmo
authors: AM
authors: Lucon
authors: Maria Adelaide Albergaria
authors: MA
authors: Pereira
mesh_terms: D000293:Adolescent; D000302:Adrenal Cortex / Q000187:drug effects / Q000473:pathology*; D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D018268:Adrenocortical Carcinoma / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D008939:Mitotane