A nomogram for individualized estimation of survival among adult patients with adrenocortical carcinoma after surgery: a retrospective analysis and multicenter validation study

Figures

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  Fig. 1. Flowchart illustrating patient selection for this study

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  Fig. 2. The formulated nomogram and its calibration plots. a This nomogram enables the prognostication of the 1-, 3- and 5-year estimates of the OS of ACC patients after surgery. Calibration plots of the nomogram performed in the b SEER training, c SEER internal validation, d the TCGA validation and e the Chinese multicenter validation set, respectively. Nomogram-predicted OS is plotted on the x-axis; actual OS is plotted on the y-axis. Dots represent nomogram-predicted probabilities. An ideal prediction would correspond to the diagonal 45° gray line slope of b–e. The score range of the nomogram is 0 to 29.3. OS overall survival, ACC adrenocortical carcinoma, SEER the Surveillance Epidemiology, and End Results database, TCGA the Cancer Genome Atlas set

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  Fig. 3. X-tile plots to identify the optimal risk score cutoff based on OS in the SEER training set. a X-tile plot for the training set. The X-tile plot was generated by dividing risk scores into three populations (low, middle and high) or two populations (low and high). Each pixel (point) of the X-tile plot represents the data from a given set of divisions. The X-axis represents all potential risk score cutoff from low to high (left to right) that define a low subset, whereas the Y-axis represents risk score cutoff value from high to low (top to bottom), that define a high subset. The arrows represent the direction in which the low subset (X-axis) and the high subset (Y-axis) increase in size. Data along the hypotenuse represent results from a single cutoff value that divides the data into high or low subsets. The coloration of the plot represents the strength of the association at each division, ranging from low (dark, black) to high (bright, red or green). Inverse associations between the risk score and survival are colored red, whereas direct associations are colored green. b The distributions of the number of patients by risk score. c Kaplan–Meier plots categorized by the low-risk…

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  Fig. 4. Kaplan–Meier survival curves categorized into low-risk and high-risk groups. Kaplan–Meier survival curves of OS in a training, b SEER internal validation; c TCGA validation; d Chinese multicenter validation set; e entire cohort of enrolled ACC patients. OS overall survival, ACC adrenocortical carcinoma, SEER the Surveillance Epidemiology, and End Results database, TCGA the Cancer Genome Atlas set

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  Fig. 5. Kaplan–Meier survival curves categorized into low-risk and high-risk groups in stratified analyses for the entire study cohort. Significance between the OS of the high-risk and low-risk patients was observed in both sex a male and b female, and tumor location, c left-sided ACC, d right-sided ACC. OS overall survival, ACC adrenocortical carcinoma

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  Fig. 6. DCA for the nomogram. Decision curve analyses depicting the clinical net benefit in the different cohorts, namely the a SEER training; b SEER internal validation; c TCGA validation; d Chinese multicenter validation set. The horizontal solid black line represents the assumption that no patients will experience the event, and the solid gray line represents the assumption that all patients will relapse. On decision curve analyses, the nomogram showed superior net benefit in all different cohorts across a range of threshold probabilities. DCA decision curve analysis, SEER Surveillance Epidemiology, and End Results database, TCGA the Cancer Genome Atlas set