CuPeR online tool predicts postsurgical outcomes in Cushing’s
Clinicians can estimate risk of disease persisting, recurring
Researchers have developed an online tool — called CuPeR — that can accurately predict the persistence or recurrence of Cushing’s disease following surgery to remove the disease-causing pituitary tumor, a study reports.
From patient data, four clinical factors were identified as predictors of postoperative outcomes: tumor site, prior pituitary surgery, symptom duration, and tumor invasiveness.
By entering each of these four factors into CuPeR, clinicians can now estimate the risk of Cushing’s disease persisting or recurring after surgery.
“This study introduced a practical, predictive model for estimating the risk of postoperative persistence and recurrence in Cushing’s disease, possibly offering a reliable tool for preoperative planning,” researchers wrote.
The study, “The CuPeR model: A dynamic online tool for predicting Cushing’s disease persistence and recurrence after pituitary surgery,” was published in the Journal of Clinical & Translational Endocrinology.
Most people with Cushing’s have surgery to remove tumor
Most people with Cushing’s disease undergo a surgical procedure, called a transsphenoidal adenomectomy, to remove the disease-causing tumor in the pituitary gland. These tumors secrete abnormally high levels of adrenocorticotropic hormone, which ultimately leads to the overproduction of cortisol and disease symptoms.
This type of surgery successfully achieves remission and long-term disease control in about 71% to 80% of patients. However, “no single predictive factor has proven effective in reliably forecasting treatment outcomes in patients with [Cushing’s disease], wrote the researchers, who used patient data to develop a model, dubbed CuPeR, to identify predictors of postoperative persistence or recurrence of Cushing’s disease.
The team first retrospectively reviewed the clinical data of 211 individuals, ages 11 to 67, with Cushing’s disease, including patient and tumor characteristics, imaging findings, and treatment details. Over a median postsurgical follow-up of 58.4 months, ranging from 4.5 to 170.4 months (about 14 years), 23 patients (11.2%) experienced persistent disease, and 10 (4.9%) had disease recurrence.
In a correlation analysis, patients with a longer duration of symptoms and a history of prior pituitary tumor surgery had a significantly increased risk of Cushing’s disease recurrence after surgery. Conversely, patients with tumors located bilaterally — when the tumor is present on both the left and right sides of the pituitary gland — had significantly lower odds of recurrence.
Model’s accuracy in predicting disease persistence, recurrence was 83%
The final model identified four key factors that independently predicted the postoperative persistence or recurrence of Cushing’s disease: Hardy’s grade, symptom duration, prior pituitary surgery, and tumor site. Hardy’s grade describes the invasiveness of a pituitary tumor, or whether it has spread into surrounding tissue, as assessed by MRI.
The model’s accuracy in predicting postoperative disease persistence or recurrence was 83%.
“The model offers significant clinical utility by providing treating surgeons with valuable insights into postoperative outcomes,” the team wrote.
The researchers then developed the CuPeR online tool, which enables the entry of all four key predictors, providing clinicians with a score that estimates the risk of disease persistence or recurrence. Higher scores correspond to an increased likelihood.
By integrating key clinical predictors into an interactive online dynamic nomogram, the CuPeR model may provide surgeons with personalized risk assessments to aid in preoperative planning.
In a survival analysis, a gradual decline in disease-free survival (DFS), or the time spent alive without the disease, was observed across all patients.
Among the four predictive factors, Hardy’s Grade 3, a more invasive tumor, was associated with a significantly worse DFS compared with Grade 0, a noninvasive tumor. Likewise, patients with a history of previous pituitary surgery had significantly worse DFS. The two other predictive factors, symptom duration and tumor site, were not associated with DFS.
“By integrating key clinical predictors into an interactive online dynamic nomogram, the CuPeR model may provide surgeons with personalized risk assessments to aid in preoperative planning,” the researchers wrote. “Its focus on preoperative data ensures broader applicability, paving the way for tailored therapeutic strategies and improved patient outcomes in diverse clinical scenarios.”
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