{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:42:38Z","timestamp":1787244158931,"version":"build-2736575974"},"reference-count":89,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T00:00:00Z","timestamp":1715040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Paragangliomas (PGLs) are rare tumors in adrenal and extra-adrenal locations. Metastasis are found in approximately 5% to 35% of PGLs, and there are no reliable predictors of metastatic disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This work aimed to develop a prognostic score of metastatic potential in PGLs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted of clinical data from a cohort with PGLs and tumor histological assessment. Patients were divided into metastatic PGL (presence of metastasis) and nonmetastatic PGL (absence of metastasis \u226596 months of follow-up) groups. Univariate and multivariable analysis were performed to identify predictors of metastatic potential. A prognostic score was developed based on coefficients of multivariable analysis. Kaplan-Meier curves were generated to estimate disease-specific survival (DSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 263 patients, 35 patients had metastatic PGL and 110 patients had nonmetastatic PGL. In multivariable analysis, 4 features were independently related to metastatic disease and composed the Prognostic Score of Paragangliomas (PSPGL): presence of central or confluent necrosis (33 points), more than 3\u2005mitosis\/10 high-power field (HPF) (28 points), extension into adipose tissue (20 points), and extra-adrenal location (19 points). A PSPGL of 24 or greater showed similar sensitivity with higher specificity than the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP). PSPGL less than or equal to 20 was associated with a risk of metastasis of approximately 10%, whereas a PSPGL of 40 or greater was associated with approximately 80%. The presence of metastasis and Ki-67 of 3% or greater were related to lower DSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The PSPGL, composed of 4 easy-to-assess parameters, demonstrated good performance in predicting metastatic potential and good ability in estimating metastasis risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvae093","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T12:28:29Z","timestamp":1715084909000},"source":"Crossref","is-referenced-by-count":8,"title":["Identification of Predictors of Metastatic Potential in Paragangliomas to Develop a Prognostic Score (PSPGL)"],"prefix":"10.1210","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1630-0975","authenticated-orcid":false,"given":"Daniela Yone Veiga","family":"Iguchi","sequence":"first","affiliation":[{"name":"Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 05403-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e3o Nunes","family":"Martins Filho","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Alberta , Alberta T6G 1C9 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3830-4686","authenticated-orcid":false,"given":"Iber\u00ea Cauduro","family":"Soares","sequence":"additional","affiliation":[{"name":"Divis\u00e3o de Anatomia Patol\u00f3gica, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo (ICESP), Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Aparecida Coelho","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Divis\u00e3o de Anatomia Patol\u00f3gica, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 05403-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ven\u00e2ncio Avancini Ferreira","family":"Alves","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Investiga\u00e7\u00e3oc M\u00e9dica LIM\/14, Departamento de Patologia, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Kawassaki","family":"Assato","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Investiga\u00e7\u00e3oc M\u00e9dica LIM\/14, Departamento de Patologia, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hoon","family":"Yang","sequence":"additional","affiliation":[{"name":"Cl\u00ednica de Endocrinologia, Hospital do Servidor P\u00fablico Municipal de S\u00e3o Paulo , S\u00e3o Paulo 01532-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2957-6148","authenticated-orcid":false,"given":"Madson Q","family":"Almeida","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Endocrinologia Molecular e Celular LIM\/25, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Candida Barisson","family":"Villares Fragoso","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Horm\u00f4nios e Gen\u00e9tica Molecular LIM\/42, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"},{"name":"Divis\u00e3o de Endocrinologia e Metabologia, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo (ICESP), Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo Freitas Cardoso","family":"Fagundes","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Endocrinologia Molecular e Celular LIM\/25, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenice B","family":"Mendonca","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Horm\u00f4nios e Gen\u00e9tica Molecular LIM\/42, Laborat\u00f3rio de Sequenciamento em Larga Escala (SELA), Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delmar Muniz","family":"Louren\u00e7o Junior","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Endocrinologia Molecular e Celular LIM\/25, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana O","family":"Hoff","sequence":"additional","affiliation":[{"name":"Divis\u00e3o de Endocrinologia e Metabologia, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo (ICESP), Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2482-4675","authenticated-orcid":false,"given":"Luciana Audi","family":"Castroneves","sequence":"additional","affiliation":[{"name":"Divis\u00e3o de Endocrinologia e Metabologia, Instituto do C\u00e2ncer do Estado de S\u00e3o Paulo (ICESP), Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Ferraz-de-Souza","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Endocrinologia Celular e Molecular LIM\/25, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo \u00a0 01246-903 , Brazil"},{"name":"School of Medicine, University of Notre Dame Australia , Fremantle WA 6160 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lucia Cardillo Correa","family":"Giannella","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Carboidratos e Radioimunoensaio LIM\/18, Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 01246-903 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Adelaide Albergaria","family":"Pereira","sequence":"additional","affiliation":[{"name":"Divis\u00e3o de Endocrinologia e Metabologia, Hospital das Cl\u00ednicas, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo 05403-000 , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2024,5,7]]},"reference":[{"issue":"1","key":"2024070105112252700_bvae093-B1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12022-022-09704-6","article-title":"Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr 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