Development and Internal Validation of a Multivariable Prediction Model for Adrenocortical-Carcinoma-Specific Mortality

Madeleine H. T. Ettaieb*, Sander M. J. van Kuijk, Annelies de Wit-Pastoors, Richard A. Feelders, Eleonora P. M. Corssmit, Elisabeth M. W. Eekhoff, Paul van der Valk, Henri J. L. M. Timmers, Michiel N. Kerstens, Heinz-Josef Klumpen, Rachel S. van Leeuwaarde, Bas Havekes, Harm R. Haak, Dutch Adrenal Network

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Adrenocortical carcinoma (ACC) has an incidence of about 1.0 per million per year. In general, survival of patients with ACC is limited. Predicting survival outcome at time of diagnosis is a clinical challenge. The aim of this study was to develop and internally validate a clinical prediction model for ACC-specific mortality. Data for this retrospective cohort study were obtained from the nine centers of the Dutch Adrenal Network (DAN). Patients who presented with ACC between 1 January 2004 and 31 October 2013 were included. We used multivariable Cox proportional hazards regression to compute the coefficients for the prediction model. Backward stepwise elimination was performed to derive a more parsimonious model. The performance of the initial prediction model was quantified by measures of model fit, discriminative ability, and calibration. We undertook an internal validation step to counteract the possible overfitting of our model. A total of 160 patients were included in the cohort. The median survival time was 35 months, and interquartile range (IQR) 50.7 months. The multivariable modeling yielded a prediction model that included age, modified European Network for the Study of Adrenal Tumors (mENSAT) stage, and radical resection. The c-statistic was 0.77 (95% Confidence Interval: 0.72, 0.81), indicating good predictive performance. We developed a clinical prediction model for ACC-specific mortality. ACC mortality can be estimated using a relatively simple clinical prediction model with good discriminative ability and calibration.

Original languageEnglish
Article number2720
Number of pages15
Issue number9
Publication statusPublished - Sept 2020


  • adrenocortical carcinoma
  • prediction
  • mortality


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