John Phillips1, Jonathan Bloom2, Vidhush Yarlagadda3, Luciana Schultz4, Jennifer Gordetsky3,4, Fabio Y Tanno5, Jose L Chambo5, Madson Q Almeida5, Maria Cbv Fragoso5, Miguel Srougi5, Victor Srougi5, Soroush Rais-Bahrami3,6,7. 1. Department of Urology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA. 2. Urologic Oncology Branch, National Institutes of Health, Bethesda, Maryland, USA. 3. Departments of, Department of, Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 4. and, Department of, Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. Division of Urology, Hospital Clinics of São Paulo, University of São Paulo Medical School, São Paulo, Brazil. 6. Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 7. O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Abstract
OBJECTIVES: To develop a preoperative nomogram that would predict the risk of a postoperative complication for pheochromocytoma patients undergoing adrenalectomy using an international database. METHODS: We retrospectively analyzed preoperative variables and postoperative outcomes in patients who underwent adrenalectomy for pheochromocytoma in three institutions from 2000 to 2017. Internal validation of a generated nomogram was carried out with receiver operating characteristics, calibration plots, and decision curve analyses. RESULTS: A total of 153 patients who had undergone 166 adrenalectomies were included in the study. Overall, post-adrenalectomy complications were seen in 30% of patients, whereas 9.6% of patients sustained a Clavien ≥3a complication. Independent predictors of a complication were a history of hypertension, body mass index, tumor size, and Charlson Comorbidity Index score. On internal validation, the multivariable model generated a nomogram that predicted a postoperative complication or clinically hemodynamic event with an area under the curve of 0.86, showed good calibration and had an overall net benefit. CONCLUSIONS: An internally validated nomogram combining body mass index, Charlson Comorbidity Index score and tumor size can predict the probability of a post-adrenalectomy complication in those with and without hypertension. The model, the first of its kind in pheochromocytoma surgery, identifies patients at risk of a postoperative complication at the time of their presentation with pheochromocytoma.
OBJECTIVES: To develop a preoperative nomogram that would predict the risk of a postoperative complication for pheochromocytomapatients undergoing adrenalectomy using an international database. METHODS: We retrospectively analyzed preoperative variables and postoperative outcomes in patients who underwent adrenalectomy for pheochromocytoma in three institutions from 2000 to 2017. Internal validation of a generated nomogram was carried out with receiver operating characteristics, calibration plots, and decision curve analyses. RESULTS: A total of 153 patients who had undergone 166 adrenalectomies were included in the study. Overall, post-adrenalectomy complications were seen in 30% of patients, whereas 9.6% of patients sustained a Clavien ≥3a complication. Independent predictors of a complication were a history of hypertension, body mass index, tumor size, and Charlson Comorbidity Index score. On internal validation, the multivariable model generated a nomogram that predicted a postoperative complication or clinically hemodynamic event with an area under the curve of 0.86, showed good calibration and had an overall net benefit. CONCLUSIONS: An internally validated nomogram combining body mass index, Charlson Comorbidity Index score and tumor size can predict the probability of a post-adrenalectomy complication in those with and without hypertension. The model, the first of its kind in pheochromocytoma surgery, identifies patients at risk of a postoperative complication at the time of their presentation with pheochromocytoma.
Authors: Marta Araujo-Castro; Rogelio García Centero; María-Carmen López-García; Cristina Álvarez Escolá; María Calatayud Gutiérrez; Concepción Blanco Carrera; Paz De Miguel Novoa; Nuria Valdés Gallego; Felicia A Hanzu; Paola Gracia Gimeno; Mariana Tomé Fernández-Ladreda; Juan Carlos Percovich Hualpa; Mireia Mora Porta; Javier Lorca Álvaro; Héctor Pian; Ignacio Ruz Caracuel; Alfonso Sanjuanbenito Dehesa; Victoria Gómez Dos Santos; Ana Serrano Romero; Cristina Lamas Oliveira Journal: Endocrine Date: 2021-08-09 Impact factor: 3.633