Abstract
PurposeSurgical removal of pheochromocytoma (PCC), including open, laparoscopic, and robot-assisted adrenalectomy, is the cornerstone of therapy, which is associated with high risk of intraoperative and postoperative life-threatening complications due to intraoperative hemodynamic instability (IHD). This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery.MethodsThe data from 112 patients with pheochromocytoma were collected at a single center between January 1, 2010, and December 31, 2019. Clinical and radiological features were selected with the least absolute shrinkage and selection operator regression analysis to predict IHD then constitute a nomogram. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultsAge, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD. The nomogram was then developed using these seven variables. The model showed good discrimination with a C-index of 0.773 (95% CI, 0.683–0.862) and an area under the receiver operating characteristic curve (AUC) of 0.739 (95% CI, 0.642–0.837). The calibration plot suggested good agreement between predicted and actual probabilities. Besides, calibration was tested with the Hosmer–Lemeshow test (P = 0.961). The decision curve showed the clinical effectiveness of the nomogram.ConclusionsOur nomogram based on clinical and CT parameters could facilitate the treatment strategy according to assessment of the risk of IHD in patients with pheochromocytoma.
Highlights
Pheochromocytoma (PCC) is a rare catecholamine-producing tumor arising from the chromaffin cells in the adrenal medulla
This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery
Age, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD
Summary
Pheochromocytoma (PCC) is a rare catecholamine-producing tumor arising from the chromaffin cells in the adrenal medulla. It is not an unusual phenomenon that pheochromocytomas were discovered as adrenal incidentalomas with the widespread use of cross-sectional imaging for unrelated disorders. Since surgical removal of pheochromocytoma is the cornerstone of therapy, intraoperative hemodynamic instability (IHD), which could cause intraoperative and postoperative catecholamine-induced life-threatening complications, is the major concern of a multidisciplinary team. Despite a number of previous studies, the predictive risk factors associated with IHD during pheochromocytoma resection remain inconclusive [3–7]. The aim was to develop and validate a nomogram that incorporated multiple preoperative radiological and clinical parameters for individual preoperative prediction of hemodynamic instability during the surgery of pheochromocytoma
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