ArticleJournal of internal medicine2026
Who can safely discontinue lifelong follow-up among patients with sporadic pheochromocytoma and paraganglioma?
Article in Journal of internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines recommend at least 10 years of follow-up for all pheochromocytoma and paraganglioma (PPGL) patients and lifelong monitoring for high-risk individuals. Nonetheless, data identifying patients who may not require routine lifelong follow-up are scarce.
methodsAmong 999 patients with PPGL, 703 who were non-metastatic, non-hereditary, and had undergone complete resection were included. Variables that significantly differed between the recurrence (n = 50) and non-recurrence groups over 10 years (n = 83) were identified, and cutoff values were determined using receiver-operating characteristic curve analysis. These very low-risk criteria were validated in an internal cohort and an external dataset from the National Institutes of Health.
resultsThe non-recurrence group was older and had smaller pheochromocytomas (PCCs) than the recurrence group, with cutoffs of 37 years and 5.7 cm, respectively. The non-recurrence group had a higher percentage of patients with pheochromocytoma of the adrenal gland scaled score (PASS) <4 or grading system for adrenal pheochromocytoma and paraganglioma (GAPP) score <3 (p = 0.027). Age >40 years (hazard ratio [HR] [95% confidence intervals] of 0.36 [0.17-0.76]), PCC size <6 cm (HR = 0.43 [0.19-0.98]), and PASS <4 or GAPP score <3 (HR = 0.37 [0.16-0.89]) were associated with lower recurrence risk. None of the patients meeting all these criteria in the internal (n = 114) and external (n = 13) validation sets experienced recurrence.
conclusionThis study suggests that routine lifelong follow-up may be unnecessary for patients with sporadic PCC aged >40 years, size <6 cm, and PASS <4 or GAPP score <3.
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