External validation of the S-GRAS score for predicting recurrence in patients with adrenocortical carcinoma: implications for adjuvant mitotane therapy
Authors' conclusion
Our findings validate the S-GRAS score in a multicenter cohort and support its use in identifying candidates for adjuvant mitotane. Non-linear modeling of Ki-67% enhances predictive precision without increasing complexity, but the performance plateau of clinical variables suggests that integrating molecular biomarkers may be necessary to improve prognostic accuracy.
Study context
- Population
- Adrenocortical carcinoma (ACC) patients from the Spanish ICARO-GETTHI/SEEN registry (1998–2023)76 recurrence events
- Participants
- 138 patients
- Comparison
- Scores 0-1 vs 2-3 vs 4-5 vs 6-7
- Outcome
- S-GRAS model performance (discrimination, calibration, accuracy) for OS and recurrence-free survival
Methodological detailsmulticenter, registry-based
- Multicenter
- Registry-based
Performance
As reported in the abstract
C-index for OS
0.706
95% CI 0.628–0.785
C-index for recurrence-free survival
0.673
95% CI 0.601–0.745
Further findings
Five-year survival by S-GRAS score group · 5 years
Five-year survival by S-GRAS score group · 5 years
- Five-year survival differed significantly across score groups
Non-linear modeling of Ki-67%
- C-index for RFS
- 0.738
- C-index for OS
- 0.761
- Adding clinical variables offered minimal benefit; 75% of recurrence variability unexplained
Adjuvant mitotane benefit by S-GRAS score
- Mitotane HR for score 4
- 0.57 (95% CI 0.34-0.97)
- Mitotane HR for score 5
- 0.46 (95% CI 0.23-0.94)
- Higher S-GRAS scores correlated with increased mitotane benefit
Original publication
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