ArticlePloS one2017
Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 72 papers, 2 of them syntheses that pooled it.
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Who cites it
72 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Predictors of recurrence of pheochromocytoma and paraganglioma: a multicenter study in Piedmont, Italy.Hypertension research : official journal of the Japanese Society of Hypertension · 2020Pooled it
- Genotype-phenotype correlations in pheochromocytoma and paraganglioma: a systematic review and individual patient meta-analysis.Endocrine-related cancer · 2019Pooled it
- Novel alternative tools for metastatic pheochromocytomas/paragangliomas prediction.Journal of endocrinological investigation · 2024Trial
- Neuroendocrine Neoplasms of the Urinary Bladder: Integrating Molecular Advances into a Refined Classification System.Endocrine pathology · 2026Review
- Biomarkers of metastatic disease in pheochromocytoma and paraganglioma.Endocrine connections · 2026Article
- Double faces of pheochromocytoma and paraganglioma-a review of integrated pathologic diagnosis.Endocrine journal · 2026Review
- The GAPP Aggressivity Score Correlates with Total Enriched Somatic Variant Burden in Sporadic Pheochromocytoma-A Pilot Study.Cancers · 2026Article
- Multi-omics insights into metastatic pheochromocytomas and paragangliomas: Mechanisms, signatures, and prediction models.Hormones (Athens, Greece) · 2026Review
- Multicenter evaluation of the PASS score as a negative predictive tool and the impact of inter-observer variability in pheochromocytoma and paraganglioma risk stratification.Journal of pathology and translational medicine · 2026Article
- Prognostic Value of a Histopathological Scoring System and the Ki67 Proliferation Index in Dogs With Phaeochromocytoma.Veterinary and comparative oncology · 2026Article
- Precision imaging and evolving therapies in paragangliomas and pheochromocytomas: from molecular diagnostics to imaging-guided management.Insights into imaging · 2026Article
- SDHB and CDK1 protein expression in metastatic pheochromocytoma and paraganglioma.Endocrine oncology (Bristol, England) · 2026Article
- The evolving roles of pathologists in paragangliomas and pheochromocytomas.Virchows Archiv : an international journal of pathology · 2026Review
- Increased HIF-2α and CD105 (endoglin) expression is associated with poor differentiation in pheochromocytomas and paragangliomas.Frontiers in endocrinology · 2026Article
- Surgical Management of a Left Main Coronary Trunk-Adjacent Functional Cardiac Paraganglioma Using Proactive Coronary Artery Bypass Grafting: A Case Report.Surgical case reports · 2026Article
- Clinical significance, prognosis, and risk model of SDHB expression loss and ERBB2 expression in pheochromocytoma and paraganglioma.Endocrine connections · 2025Article
- Current Understanding of Carotid Body Paraganglioma Management.Vascular specialist international · 2025Review
- Presurgical Succinate MetAstatic Risk Tool (P-SMART) in Paragangliomas.Endocrine pathology · 2025Article
- Metastatic Malignant Phaeochromocytoma in Ascitic Fluid: Cytological Diagnosis of a Rare Entity.Cytopathology : official journal of the British Society for Clinical Cytology · 2025Article
- Prognosis and tumor microenvironment in pseudohypoxic pheochromocytoma/paraganglioma.Virchows Archiv : an international journal of pathology · 2025Article
12 more citing papers are in PubMed but not listed here.
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9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe Grading system for Adrenal Pheochromocytoma and Paraganglioma (GAPP) was proposed for predicting the metastatic potential of pheochromocytoma and paraganglioma to overcome the limitations of the Pheochromocytoma of the Adrenal Scaled Score (PASS). However, to date, no study validating the GAPP has been conducted, and previous studies did not include mutations in the succinate dehydrogenase type B (SDHB) gene in the score calculation. In this retrospective cohort study, we validated the prediction ability of GAPP and assessed whether it would be improved by inclusion of the loss of SDHB immunohistochemical staining.
methodsWe divided the tumors into non-metastatic and metastatic groups based on the presence of synchronous or metachronous metastases. The GAPP score and PASS at the initial operation were measured. Moreover, we combined some GAPP parameters with the immunohistochemical staining of SDHB to obtain a modified GAPP (M-GAPP) score.
resultsMetastasis occurred in 15/72 (20.8%) patients, with a mean follow-up of 43.5 months. Loss of SDHB staining was more frequent (P = 0.044) in the metastatic group. The GAPP score (P = 0.006), PASS (P = 0.003), and M-GAPP score (P<0.001) were all higher in the metastatic group. Twelve of 40 (30.0%) moderately or poorly differentiated tumors, as defined by the GAPP score, and 12/34 (35.3%) tumors with a PASS ≥4 were metastatic. Conversely, 10/19 (52.6%) tumors with an M-GAPP score ≥3 were metastatic. The area under the curve of the M-GAPP score (0.822) was significantly higher than that of the GAPP (0.728) (P = 0.012), but similar to that of the PASS (0.753) (P = 0.411). The GAPP (P = 0.032) and M-GAPP scores (P = 0.040), but not PASS (P = 0.200), negatively correlated with metastasis-free survival.
conclusionThe GAPP was validated, and M-GAPP, a combination of some GAPP parameters and loss of SDHB staining, might be useful for the prediction of the metastatic potential of pheochromocytoma and paraganglioma.
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