Assessment Of Postoperative Outcomes And Construction Of A Prognostic Model For Patients With Primary Aldosteronism After Adrenalectomy Based On CT Scan Diagnosis Of Unilateral Adenoma Without Adrenal Vein Sampling

Purpose: To assessment of postoperative outcomes and construction of a prognostic model for patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling.Methods: This is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow up of at least 6-12 months from Jan 2012 to Dec 2021 in a single center,decision for adrenalectomy was based on CT scan and adrenal vein sampling(AVS)was not used.Based on standardized Primary Aldosteronism Surgical Outcomes(PASO)criteria,172 patients were finally included in the training set.Risk factors affecting patients’ biochemical prognosis were analyzed,which led to the development of a risk assessment model,and an additional 20 patients were selected to validate the model between January and December 2021.Results: 1.Clinical characteristics of patients: in the training dataset,complete clinical success was achieved in 71 patients(41.3%),partial success in 87(50.6%),and absent success in 14(8.1%).Biochemical outcomes showed that 151 patients(87.8%)completely cured,14 patients(8.1%)got a partial biochemical success and an absent biochemical success was found in 7 patients(4.1%).The mean age of the patients was 52.1±10.9 years,including 82 male patients(47.7%)and 90 female patients(52.3%).28.6% of the patients had a history of hereditary hypertension,the mean duration of hypertension was 55(12-144)months,the mean blood potassium level was 3.56(1.98-4.28)mmol/L,and 48.2% of the patients had hypokalemia The mean adenoma size was 15.2±3.9 mm,including 93 cases(54%)on the left side,and the mean age and BMI at the time of surgery were 52.4±11.0 years and 26.3±1.9 kg/m2,respectively,with 28.5% of patients having a history of smoking and 12.7% having diabetes mellitus.2.Results of statistical analysis: In the ROC,the optimal cut-off age for incomplete biochemical remission was 49.5 years(area under the curve [AUC]=0.643),the optimal BMI cut-off for incomplete biochemical remission was 28.4 kg/m2(AUC=0.64),and the optimal tumor size cut-off was 10.5 mm(AUC=0.67),respectively.Analysis using multifactorial stepwise logistic regression showed that age(P=0.013),body mass index(BMI,P=0.006),tumor size(P=0.04),mean arterial pressure(MAP)(P=0.032)and serum potassium(P= 0.012)were independent risk factors for incomplete biochemical success.3.Model construction and evaluation:Based on the results of the above statistical analysis,this study constructed a line graph prognostic assessment model for patients after unilateral primary aldosterone surgery,which showed good predictive ability in both the training(AUC 0.856 [95% CI 0.775-0.937])and validation(AUC 0.854 [95% CI,0.688-1.000])datasets both showed good predictive power,indicating that the model was significantly better than single factors such as age,BMI,and tumor size.Meanwhile,the results of the calibration curve and decision curve analysis of the nomogram indicated that the model was superior in predicting incomplete biochemical remission rates.Conclusion: 1.Although CT can only provide anatomical features of the adrenal glands and does not provide additional functional information,the results of this study showed a high rate of complete biochemical success at 12 months after CT-based diagnosis of adrenalectomy.2,For patients with primary aldosterone,age,MAP,BMI,tumor size,and serum potassium were independent risk factors for incomplete biochemical success.3,The nomogram prognostic assessment model for patients after unilateral primary aldosterone surgery constructed in this study can accurately and reliably predict incomplete biochemical success.