scholarly journals Nomogram-Based Preoperative Score for Predicting Clinical Outcome in Unilateral Primary Aldosteronism

2020 ◽  
Vol 105 (12) ◽  
pp. e4382-e4392
Author(s):  
Yi Yang ◽  
Tracy Ann Williams ◽  
Ying Song ◽  
Shumin Yang ◽  
Wenwen He ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Primary Aldosteronism ◽  
Validation Cohort ◽  
Clinical Success ◽  
Characteristic Curve ◽  
Target Organ Damage ◽  
Asian Population ◽  
Unilateral Adrenalectomy ◽  
Training Cohort ◽  
Preoperative Score

Abstract Context More than half of patients diagnosed with unilateral primary aldosteronism (UPA) suffer from persisting hypertension after unilateral adrenalectomy. Objective The objective of this work is to develop and validate a nomogram-based preoperative score (NBPS) to predict clinical outcomes after unilateral adrenalectomy for UPA. Design and Setting The NBPS was developed in an Asian cohort by incorporating predictors independently associated with remission of hypertension after unilateral adrenalectomy for UPA and validated in a Caucasian cohort. Participants Participants comprised patients with UPA achieving complete biochemical success after unilateral adrenalectomy. Main Outcome Measure Measurements included the predictive performance of the NBPS compared with 2 previously developed outcome prediction scores: aldosteronoma resolution score (ARS) and primary aldosteronism surgical outcome (PASO) score. Results Ninety-seven of 150 (64.7%) patients achieved complete clinical success after unilateral adrenalectomy in the training cohort and 57 out of 165 (34.5%) in the validation cohort. A nomogram was established incorporating sex, duration of hypertension, aldosterone-to-renin ratio, and target organ damage. The nomogram showed good C indices and calibration curves both in Asian and Caucasian cohorts. The area under the receiver operating characteristic curve (AUC) of the NBPS for predicting hypertension remission in the training cohort was 0.853 (0.786-0.905), which was superior to the ARS (0.745 [0.667-0.812], P = .019) and PASO score (0.747 [0.670-0.815], P = .012). The AUC of the NBPS in the validation cohort was 0.830 (0.764-0.884), which was higher than the ARS (0.745 [95% CI, 0.672-0.810], P = .045), but not significantly different from the PASO score (0.825 [95% CI, 0.758-0.880], P = .911). Conclusion The NBPS is useful in predicting clinical outcome for UPA patients, especially in the Asian population.

scholarly journals Treatment of Unilateral PA by Adrenalectomy: Potential Reasons for Incomplete Biochemical Cure

2018 ◽  
Vol 127 (02/03) ◽  
pp. 100-108 ◽  
Author(s):  
Yuhong Yang ◽  
Martin Reincke ◽  
Tracy Williams
Keyword(s):  
Primary Aldosteronism ◽  
Clinical Success ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Unilateral Adrenalectomy ◽  
Cerebrovascular Events ◽  
Medication Dosage ◽  
Aldosterone Production ◽  
Clinical Benefits ◽  
Biochemical Cure

AbstractThe importance of an early diagnosis and appropriate management of patients with primary aldosteronism (PA) has become increasingly clear because of the adverse impact of the disorder on cardiovascular and cerebrovascular events and target organ damage. Adrenalectomy potentially cures patients with unilateral PA resulting in normalisation of blood pressure or significant clinical improvements in the majority of patients. Different criteria have been used to evaluate outcomes of unilateral adrenalectomy. Clinical remission (cure of hypertension) is observed in 6% to 86% of patients and clinical benefits from surgery are seen in the majority. Several factors have been identified that predict clinical success after surgery such as age, sex, anti-hypertensive medication dosage and known duration of hypertension. Biochemical remission of PA after unilateral adrenalectomy, characterised by the resolution of hyperaldosteronism and correction of pre-surgical hypokalaemia, is observed in 67% to 100% of patients with unilateral PA. In only a small proportion of patients, adrenalectomy fails to resolve hyperaldosteronism and inappropriate aldosterone production persists after surgery. In this review we discuss the potential reasons for failing to cure hyperaldosteronism after unilateral adrenalectomy for unilateral primary aldosteronism.

scholarly journals OR04-6 Predictors of Clinical Outcome after Adrenalectomy for Unilateral Primary Aldosteronism

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Caio Moises ◽  
Natalia Alencar ◽  
Thaís Castanheira ◽  
Leticia Vilela ◽  
Marcela Rassi-Cruz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Primary Aldosteronism ◽  
Independent Predictor ◽  
Clinical Success ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Unilateral Adrenalectomy ◽  
Common Cause ◽  
Molecular Features ◽  
Endocrine Hypertension

Abstract Primary aldosteronism (PA) is the most common cause of endocrine hypertension (HT) with an estimated prevalence of 10% in referred populations and 15-20% in patients with resistant hypertension. The most common cause of unilateral PA is aldosterone-producing adenomas (APAs). HT and hypokalemia improve in nearly 100% of patients with unilateral PA after unilateral adrenalectomy. However, complete clinical success (defined as blood pressure ≤130x80 mmHg without anti-hypertensive drugs) has been reported in about 50% (range, 35-80%) of patients with unilateral PA after surgery. HT duration and severity have been associated with clinical outcome after adrenalectomy, but few reports with a limited number of cases evaluated the prognostic role of somatic KCNJ5 mutations. In this study, our aim was to determine clinical and molecular features associated with complete clinical success after unilateral adrenalectomy in unilateral PA patients. We retrospectively evaluated 103 PA patients (42 males; median age 49 yrs, 20-74) with a median follow-up of 25 months. Hypokalemia was present in 78% of the cases. Anatomopathological analysis revealed 94 APAs and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 mutations were identified in 27 out of 67 (40%) tumors: p.Gly151Arg (n= 13), p.Leu168Arg (n= 13) and p.Glu145Gln (n= 1). Complete clinical success was reported in 32 out of 103 (31%) patients. In univariate analysis, HT duration, body mass index (BMI kg/m2), female sex and somatic KCNJ5mutations were associated with HT resolution after adrenalectomy. Complete clinical success was reported in 50% of patients with HT duration ≤5 yrs (vs. 24% with HT duration >5 yrs; p= 0.011), in 40% of patients with BMI <25 (vs. 22% with BMI ≥25; p= 0.042), in 38% of women (vs. 21% of men; p= 0.079) and in 70% of the patients with tumors harboring KCNJ5 somatic mutations (vs. 30% with WT tumors; p= 0.003). According to a stepwise multivariate logistic regression analysis, only the presence of a somatic KCNJ5 mutation was an independent predictor of complete success after adrenalectomy (relative risk 4.8, 95% confidence interval 1.24 to 19.21; p= 0.023). In conclusion, the presence of a somatic KCNJ5 mutation was an independent predictor of complete clinical success after unilateral adrenalectomy in patients with unilateral PA.

Arterial Stiffness Is Associated with Clinical Outcome and Cardiorenal Injury in Lateralized Primary Aldosteronism

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Chieh-Kai Chan ◽  
Wei-Shiung Yang ◽  
Yen-Hung Lin ◽  
Kuo-How Huang ◽  
Ching-Chu Lu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Clinical Outcome ◽  
Left Ventricular Mass ◽  
Primary Aldosteronism ◽  
Clinical Success ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass

Abstract Context The association between arterial stiffness and clinical outcome in lateralized primary aldosteronism (PA) patients after adrenalectomy has not been clearly identified. Objective We hypothesized that arterial stiffness estimated by brachial-ankle pulse wave velocity (baPWV) before adrenalectomy was associated with the clinical outcomes and cardiorenal injury in lateralized PA patients after adrenalectomy. Design and Patients We designed a retrospective observational cohort study. We collected lateralized PA patients who had undergone adrenalectomy between 2013 and 2016 from the Taiwan Primary Aldosteronism Investigation database. The primary outcome was achieving complete clinical success at 1 year after adrenalectomy. The secondary outcome was estimated glomerular filtration rate declining over 20% and improved left ventricular mass index. Results We enrolled 221 patients with lateralized PA (50.7% men; mean age, 51.9 years), of whom 101 patients (45.7%) achieved complete clinical success at the 1-year follow-up assessment after adrenalectomy. Lower baPWV before adrenalectomy (odds ratio = 0.998; 95% confidence interval, 0.996-0.999; P = 0.003) correlated with higher likelihood of complete clinical success by multivariate logistic regression analysis. Multifactorial adjusted generalized additive model demonstrated that preoperative baPWV<1600 cm/sec was significantly associated with complete cure of hypertension. In addition, higher preoperative baPWV was associated with renal function decline and less left ventricular mass regression after adrenalectomy in lateralized PA patients during the follow-up period. Conclusions Our study demonstrated that the preoperative severe arterial stiffness was associated with absent complete clinical success in lateralized PA patients after adrenalectomy, and this effect may contribute to cardiorenal injury, which at least partially explains kidney function deterioration and lessened regression of heart mass.

scholarly journals Nomogram to predict primary non-response to infliximab in patients with Crohn’s disease: a multicenter study

2020 ◽  
Author(s):  
Xiao-Qi Ye ◽  
Jing Cai ◽  
Qiao Yu ◽  
Xiao-Cang Cao ◽  
Yan Chen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Mucosal Healing ◽  
Clinical Usefulness ◽  
Secondary Outcome ◽  
Training Cohort ◽  
Graphical Tool ◽  
Therapeutic Decision Making

Abstract Background Infliximab (IFX) is effective at inducing and maintaining clinical remission and mucosal healing in patients with Crohn’s disease (CD); however, 9%–40% of patients do not respond to primary IFX treatment. This study aimed to construct and validate nomograms to predict IFX response in CD patients. Methods A total of 343 patients diagnosed with CD who had received IFX induction from four tertiary centers between September 2008 and September 2019 were enrolled in this study and randomly classified into a training cohort (n = 240) and a validation cohort (n = 103). The primary outcome was primary non-response (PNR) and the secondary outcome was mucosal healing (MH). Nomograms were constructed from the training cohort using multivariate logistic regression. Performance of nomograms was evaluated by area under the receiver-operating characteristic curve (AUC) and calibration curve. The clinical usefulness of nomograms was evaluated by decision-curve analysis. Results The nomogram for PNR was developed based on four independent predictors: age, C-reactive protein (CRP) at week 2, body mass index, and non-stricturing, non-penetrating behavior (B1). AUC was 0.77 in the training cohort and 0.76 in the validation cohort. The nomogram for MH included four independent factors: baseline Crohn’s Disease Endoscopic Index of Severity, CRP at week 2, B1, and disease duration. AUC was 0.79 and 0.72 in the training and validation cohorts, respectively. The two nomograms showed good calibration in both cohorts and were superior to single factors and an existing matrix model. The decision curve indicated the clinical usefulness of the PNR nomogram. Conclusions We established and validated nomograms for the prediction of PNR to IFX and MH in CD patients. This graphical tool is easy to use and will assist physicians in therapeutic decision-making.

A urine exosomal circRNA classifier for detection of high-grade prostate cancer at initial biopsy: A multicenter, retrospective study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5522-5522
Author(s):  
Liaoyuan Li ◽  
Wen Tao ◽  
Yadi He ◽  
Tao He ◽  
Qing Li ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Circular Rna ◽  
High Grade ◽  
Training Cohort ◽  
Potential Biomarker ◽  
Initial Biopsy

5522 Background: The low specificity of prostate-specific antigen (PSA) has resulted in the overdiagnosis and overtreatment of clinically indolent prostate cancer (PCa). We aimed to identify a urine exosomal circular RNA (circRNA) classifier that could detect high-grade (Gleason score [GS]7 or greater) PCa. Methods: We did a three-stage study that enrolled eligible participants, including PCa-free men, 45 years or older, scheduled for an initial prostate biopsy due to suspicious digital rectal examination findings and/or PSA levels (limit range, 2.0-20.0 ng/mL), from four hospitals in China. We used RNA sequencing and digital droplet polymerase chain reaction to identify 18 candidate urine exosomal circRNAs that were increased in 11 patients with high-grade PCa compared with 11 case-matched patients with benign prostatic hyperplasia. Using a training cohort of eligible participants, we built a urine exosomal circRNA classifier (Ccirc) to detect high-grade PCa. We then evaluated the classifier in discrimination of GS7 or greater from GS6 and benign disease on initial biopsy in two independent cohorts. We used the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to evaluate diagnostic performance, and compared Ccirc with standard of care (SOC) (ie, PSA level, age, race, and family history). Results: Between June 1, 2016, and July 31, 2019, we recruited 356 participants to the training cohort, and 442 and 325 participants to the two independent validation cohorts. We identified a Ccirc containing five differentially expressed circRNAs (circ_0049335, circ_0056536, circ_0004028, circ_0008475, and circ_0126027) that could detect high-grade PCa. Ccirc showed higher accuracy than SOC to distinguish individuals with high-grade PCa from controls in both the training cohort and the validation cohorts. (AUC 0.831 [95% CI 0.765-0.883] vs 0.724 [0.705-0.852], P = 0.032 in the training cohort; 0.823 [0.762-0.871] vs 0.706 [0.649-0.762], P = 0.007 in validation cohort 1; and 0.878 [0.802-0.943] vs 0.785 [0.701-0.890], P = 0.021 for validation cohort 2). In all three cohorts, Ccirc had higher sensitivity (range 71.6-87.2%) and specificity (82.3-90.7%) than did SOC (sensitivity, 42.3-68.2%; specificity, 40.1-62.3%) to detect high-grade PCa. Using a predefined cut point, 202 of 767 (26.3%) biopsies would have been avoided, missing only 6% of patients with dominant pattern 4 high-risk GS 7 disease. Conclusions: Ccirc is a potential biomarker for high-grade PCa among suspicious men.

scholarly journals Comprehensive Analysis of the Functions, Prognostic and Diagnostic Values of RNA Binding Proteins in Head and Neck Squamous Cell Carcinoma

2021 ◽  
Author(s):  
Xueping Ke ◽  
Zhen Fu ◽  
Jingjing Yang ◽  
Shijin Yu ◽  
Tingyuan Yan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cell Carcinoma ◽  
Prognostic Model ◽  
Rna Binding ◽  
Cox Regression ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Training Cohort

Abstract Background: Increasing evidence has suggested that RNA binding protein (RBP) dysregulation plays an important part in tumorigenesis. Here, we sought to explore the potential molecular functions and clinical significance of RBP and develop diagnostic and prognostic signatures based on RBP in patients with head and neck squamous cell carcinoma (HNSCC). Methods: The Limma package was applied to identify the differently expressed RBPs between HNSCC and normal samples with |log2 fold change (FC)|≥1 and false discovery rate (FDR)<0.05. the immunohistochemistry images from the Human Protein Atlas database The diagnostic signature based on RBP was built by LASSO-logistic regression and random forest and the prognostic signature based on RBP was constructed by LASSO and stepwise Cox regression analysis in training cohort and validated in validation cohort. All these analyses were performed using the R software.Results: A total of 84 aberrantly expressed RBPs were obtained, comprising 41 up-regulated and 43 down-regulated RBPs. Seven RBP genes (CPEB3, PDCD4, ENDOU, PARP12, DNMT3B, IGF2BP1, EXO1) were identified as diagnostic related hub gene and were used to establish a diagnostic RBP signature risk score (DRBPS) model by the coefficients in LASSO-logistic regression analysis and shown high specificity and sensitivity in the training (area under the receiver operating characteristic curve [AUC] = 0.998), and in all validation cohorts (AUC > 0.95 for all). Similarly, seven RBP genes (MKRN3, ZC3H12D, EIF5A2, AFF3, SIDT1, RBM24 and NR0B1) were identified as prognosis associated hub genes by least absolute shrinkage and selection operator (LASSO) and stepwise multiple Cox regression analyses and were used to construct the prognostic model named as PRBPS. The area under the curve of the time-dependent receiver operator characteristic curve of the prognostic model were 0.664 at 3 years and 0.635 at 5 years in training cohort and 0.720, 0.777 in the validation cohort, showing a favorable predictive effificacy for prognosis in HNSCC.Conclusions: Our results demonstrate the values of consideration of RBP in the diagnosis and prognosis for HNSCC and provide a novel insights to understand potential role of dysregulated RBP in HNSCC.

scholarly journals Acute Tumor Transition Angle on Computed Tomography Predicts Chromosomal Instability Status of Primary Gastric Cancer: Radiogenomics Analysis from TCGA and Independent Validation

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 641 ◽  
Author(s):  
Ying-Chieh Lai ◽  
Ta-Sen Yeh ◽  
Ren-Chin Wu ◽  
Cheng-Kun Tsai ◽  
Lan-Yan Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Chromosomal Instability ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Genomic Analysis ◽  
Ct Imaging ◽  
The Cancer Genome Atlas ◽  
Tumor Diameter ◽  
Training Cohort

Chromosomal instability (CIN) of gastric cancer is correlated with distinct outcomes. This study aimed to investigate the role of computed tomography (CT) imaging traits in predicting the CIN status of gastric cancer. We screened 443 patients in the Cancer Genome Atlas gastric cancer cohort to filter 40 patients with complete CT imaging and genomic data as the training cohort. CT imaging traits were subjected to logistic regression to select independent predictors for the CIN status. For the validation cohort, we prospectively enrolled 18 gastric cancer patients for CT and tumor genomic analysis. The imaging predictors were tested in the validation cohort using receiver operating characteristic curve (ROC) analysis. Thirty patients (75%) in the training cohort and 9 patients (50%) in the validation cohort had CIN subtype gastric cancers. Smaller tumor diameter (p = 0.017) and acute tumor transition angle (p = 0.045) independently predict CIN status in the training cohort. In the validation cohort, acute tumor transition angle demonstrated the highest accuracy, sensitivity, and specificity of 88.9%, 88.9%, and 88.9%, respectively, and areas under ROC curve of 0.89. In conclusion, this pilot study showed acute tumor transition angle on CT images may predict the CIN status of gastric cancer.

scholarly journals Individualized predictions of early isolated distal deep vein thrombosis in patients with acute ischemic stroke: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hao-Ran Cheng ◽  
Gui-Qian Huang ◽  
Zi-Qian Wu ◽  
Yue-Min Wu ◽  
Gang-Qiang Lin ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Training Cohort ◽  
Vein Thrombosis ◽  
Distal Deep Vein Thrombosis ◽  
Deep Vein

Abstract Background Although isolated distal deep vein thrombosis (IDDVT) is a clinical complication for acute ischemic stroke (AIS) patients, very few clinicians value it and few methods can predict early IDDVT. This study aimed to establish and validate an individualized predictive nomogram for the risk of early IDDVT in AIS patients. Methods This study enrolled 647 consecutive AIS patients who were randomly divided into a training cohort (n = 431) and a validation cohort (n = 216). Based on logistic analyses in training cohort, a nomogram was constructed to predict early IDDVT. The nomogram was then validated using area under the receiver operating characteristic curve (AUROC) and calibration plots. Results The multivariate logistic regression analysis revealed that age, gender, lower limb paralysis, current pneumonia, atrial fibrillation and malignant tumor were independent risk factors of early IDDVT; these variables were integrated to construct the nomogram. Calibration plots revealed acceptable agreement between the predicted and actual IDDVT probabilities in both the training and validation cohorts. The nomogram had AUROC values of 0.767 (95% CI: 0.742–0.806) and 0.820 (95% CI: 0.762–0.869) in the training and validation cohorts, respectively. Additionally, in the validation cohort, the AUROC of the nomogram was higher than those of the other scores for predicting IDDVT. Conclusions The present nomogram provides clinicians with a novel and easy-to-use tool for the prediction of the individualized risk of IDDVT in the early stages of AIS, which would be helpful to initiate imaging examination and interventions timely.

scholarly journals Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Shen ◽  
Feng Guo ◽  
Yan Sun ◽  
Jingyuan Zhao ◽  
Jin Hu ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Postoperative Pancreatic Fistula ◽  
Individual Risk ◽  
Calibration Plot ◽  
Multivariable Logistic Regression Analysis ◽  
Lasso Regression ◽  
Training Cohort ◽  
Significant Difference

Abstract Background Postoperative pancreatic fistula (POPF) represents the most common complication following pancreaticoduodenectomy (PD). Predictive models are needed to select patients with a high risk of POPF. This study was aimed to establish an effective predictive nomogram for POPF following PD. Methods Consecutive patients who had undergone PD between January 2016 and May 2020 at a single institution were analysed retrospectively. A predictive nomogram was established based on a training cohort, and Lasso regression and multivariable logistic regression analysis were used to evaluate predictors. The predictive abilities of the predicting model were assessed for internal validation by the area under the receiver operating characteristic curve (AUC) and calibration plot using bootstrap resampling. The performance of the nomogram was compared with that of the currently used a-FRS model. Results A total of 459 patients were divided into a training cohort (n = 302) and a validation cohort (n = 157). No significant difference was observed between the two groups with respect to clinicopathological characteristics. The POPF rate was 16.56%. The risk factors of POPF POPF were albumin difference, drain amylase value on postoperative day 1, pancreas texture, and BMI, which were all selected into a nomogram. Nomogram application revealed good discrimination (AUC = 0.87, 95% CI: 0.81–0.94, P <  0.001) as well as calibration abilities in the validation cohort. The predictive value of the nomogram was better than that of the a-FRS model (AUC: 0.87 vs 0.62, P <  0.001). Conclusions This predictive nomogram could be used to evaluate the individual risk of POPF in patients following PD, and albumin difference is a new, accessible predictor of POPF after PD. Trial registration This study was registered in the Chinese Clinical Trial Register (ChiCTR2000034435).

scholarly journals An Immune-Related Gene Pairs Signature for Predicting Survival in Glioblastoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Sheng Wang ◽  
Xia Xu
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
The Cancer Genome Atlas ◽  
Related Gene ◽  
Training Cohort ◽  
Gene Pairs ◽  
Immune Related Gene ◽  
Genome Atlas

Background: Glioblastoma (GBM) is the frequently occurring and most aggressive form of brain tumors. In the study, we constructed an immune-related gene pairs (IRGPs) signature to predict overall survival (OS) in patients with GBM.Methods: We established IRGPs with immune-related gene (IRG) matrix from The Cancer Genome Atlas (TCGA) database (Training cohort). After screened by the univariate regression analysis and least absolute shrinkage and selection operator (LASSO) regression analysis, IRGPs were subjected to the multivariable Cox regression to develop an IRGP signature. Then, the predicting accuracy of the signature was assessed with the area under the receiver operating characteristic curve (AUC) and validated the result using the Chinese Glioma Genome Atlas (CGGA) database (Validation cohorts 1 and 2).Results: A 10-IRGP signature was established for predicting the OS of patients with GBM. The AUC for predicting 1-, 3-, and 5-year OS in Training cohort was 0.801, 0.901, and 0.964, respectively, in line with the AUC of Validation cohorts 1 and 2 [Validation cohort 1 (1 year: 0.763; 3 years: 0.786; and 5 years: 0.884); Validation cohort 2 (1 year: 0.745; 3 years: 0.989; and 5 years: 0.987)]. Moreover, survival analysis in three cohorts suggested that patients with low-risk GBM had better clinical outcomes than patients with high-risk GBM. The univariate and multivariable Cox regression demonstrated that the IRGPs signature was an independent prognostic factor.Conclusions: We developed a novel IRGPs signature for predicting OS in patients with GBM.

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