Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Laboratory of Morphology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
J Endocrinol Invest. 2024 Jan;47(1):115-129. doi: 10.1007/s40618-023-02129-w. Epub 2023 Jun 9.
We aimed to develop a nomogram model of overall survival (OS) and cancer-specific survival (CSS) in patients with differentiated thyroid cancer with distant metastases, and to evaluate and validate the nomogram. Also, its prognostic value was compared with that of the 8th edition of the American Joint Committee on Cancer tumor-node-metastasis staging system (AJCC8SS).
Patients with distant metastatic differentiated thyroid cancer (DMDTC) from 2004 to 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) Program to extract the clinical variables used for analysis. A total of 906 patients were divided into a training set (n = 634) and validation set (n = 272). OS and CSS were selected as the primary end point and secondary end point. LASSO regression analysis and multivariate Cox regression analysis were applied to screen variables for constructing OS and CSS nomograms for survival probability at 3, 5, and 10 years. Nomograms were evaluated and validated using the consistency index (C-index), time-dependent receiver operator characteristic (ROC) curves, area under the ROC curve, calibration curves, and decision curve analysis (DCA). The predictive survival of the nomogram was compared with that of AJCC8SS. Kaplan-Meier curves and log-rank tests were used to evaluate the risk-stratification ability OS and CSS nomograms.
CS and CSS nomograms included six independent predictors: age, marital status, type of surgical procedure, lymphadenectomy, radiotherapy, and T stage. The C-index for the OS nomogram was 0.7474 (95% CI = 0.7199-0.775), and that for the CSS nomogram was 0.7572 (0.7281-0.7862). The nomogram showed good agreement with the "ideal" calibration curve in the training set and validation sets. DCA confirmed that the survival probability predicted by the nomogram had high clinical predictive value. The nomogram could stratify patients more accurately, and showed more robust accuracy and predictive power, than AJCC8SS.
We established and validated prognostic nomograms for patients with DMDTC, which had significant clinical value compared with AJCC8SS.
本研究旨在建立一个用于预测伴有远处转移的分化型甲状腺癌（DTC）患者总生存（OS）和癌症特异性生存（CSS）的列线图模型，并对其进行评估和验证。同时，还将其与第 8 版美国癌症联合委员会肿瘤-淋巴结-转移分期系统（AJCC8SS）的预后价值进行比较。
本研究从监测、流行病学和最终结果（SEER）数据库中提取了 2004 年至 2015 年期间患有远处转移性分化型甲状腺癌（DMDTC）患者的临床变量进行分析。共纳入 906 例患者，分为训练集（n=634）和验证集（n=272）。OS 和 CSS 分别作为主要终点和次要终点。采用 LASSO 回归分析和多因素 Cox 回归分析筛选变量，构建生存概率为 3、5 和 10 年的 OS 和 CSS 列线图。采用一致性指数（C-index）、时间依赖性接受者操作特征（ROC）曲线、ROC 曲线下面积、校准曲线和决策曲线分析（DCA）评估和验证列线图。比较列线图与 AJCC8SS 的预测生存能力。Kaplan-Meier 曲线和对数秩检验用于评估 OS 和 CSS 列线图的风险分层能力。
CS 和 CSS 列线图包括 6 个独立预测因子：年龄、婚姻状况、手术类型、淋巴结清扫术、放疗和 T 分期。OS 列线图的 C-index 为 0.7474（95%CI：0.7199-0.775），CSS 列线图的 C-index 为 0.7572（0.7281-0.7862）。在训练集和验证集中，列线图与“理想”校准曲线吻合良好。DCA 证实，列线图预测的生存概率具有较高的临床预测价值。与 AJCC8SS 相比，列线图能够更准确地对患者进行分层，具有更高的准确性和预测能力。
本研究建立并验证了用于预测 DMDTC 患者预后的列线图模型，与 AJCC8SS 相比具有显著的临床价值。
