Researchers developed nomograms that stratified patients with adrenocortical carcinoma (ACC) into viable prognostic groups, according to a study published in JAMA Surgery.1

Prognostic factors for patients with ACC are poorly defined. Investigators sought to propose nomograms for individual risk prediction in patients who had curative surgical resection of ACC.

Investigators used data from 148 patients who underwent surgery for ACC between March 17, 1994 and December 22, 2014, to propose nomograms to predict recurrence-free survival and overall survival.

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Median patient age was 53 years and 65.5% were female. Approximately one-third of patients had a functional tumor and median tumor size was 11.2 cm. Ro resection was performed on 77.7% of patients and 8.8% of patients had N1 disease.

Factors that determined RFS prediction included tumor size of at least 12 cm (P < .001), positive nodal status (P = .01), stage 3/4 (P = .07), cortisol-secreting tumor (P = .01), and capsular invasion (P = .04). Factors that were chosen to predict overall survival included tumor size of at least 12 cm (P = .05), positive nodal status (P = .001), and R1 margin (P = .001).

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Independent predictors of survival and recurrence risk were used to create the nomograms. The investigators used C statistics, calibration plots, and Kaplan-Meier curves to determine the nomograms’ discriminative ability and calibration. Results showed that the nomograms were successful in stratifying patients into prognostic groups.


  1. Kim Y, Margonis GA, Prescott JD, et al. Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma [published online ahead of print December 16, 2015]. JAMA Surg. doi: 10.1001/jamasurg.2015.4516.