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The following is a summary of “Identification of Predictors of Metastatic Potential in Paragangliomas to Develop a Prognostic Score (PSPGL),” published in the July 2024 issue of Endocrinology by Iguchi, et al.

Paragangliomas (PGLs) are uncommon tumors found in adrenal and extra-adrenal sites, with metastasis occurring in 5% to 35% of cases. Predicting metastatic potential remained challenging. For a study, researchers sought to develop a prognostic score (Prognostic Score of Paragangliomas, PSPGL) to assess the metastatic potential of PGLs based on clinical and histological features.

The retrospective analysis reviewed clinical data and histological assessments of patients with PGL, categorizing them into metastatic PGL (with metastasis) and nonmetastatic PGL (without metastasis over ≥96 months). Univariate and multivariable analyses identified predictors of metastasis. The PSPGL was derived using coefficients from multivariable analysis. Kaplan-Meier curves assessed disease-specific survival (DSS).

Among 263 patients, 35 had metastatic PGLs, and 110 had nonmetastatic PGLs. Multivariable analysis identified four independent predictors of metastatic disease, comprising the PSPGL: central or confluent necrosis (33 points), >3 mitoses/10 high-power field (HPF) (28 points), invasion into adipose tissue (20 points), and extra-adrenal location (19 points). A PSPGL score ≥24 demonstrated higher specificity and similar sensitivity than existing scores (PASS and GAPP). PSPGL ≤20 correlated with approximately 10% metastasis risk, while PSPGL ≥40 indicated approximately 80%. The presence of metastasis and Ki-67 ≥3% were associated with reduced DSS.

PSPGL, utilizing four easily assessable parameters, effectively predicted metastatic potential and estimated metastasis risk in patients with PGL. It offered a practical tool for clinicians to prognosticate PGL outcomes.

Reference: academic.oup.com/jes/article/8/7/bvae093/7666587