Nielsen Stanton, Kuchta Kristine, Huang Grace, Zuber Samuel, Holoubek Simon, Karcioglu Amanda, Khokar Amna, Prinz Richard, Moo-Young Tricia
Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
The University of Chicago Medical Center Chicago, Chicago, IL, USA.
World J Surg. 2025 Apr;49(4):1011-1021. doi: 10.1002/wjs.12434. Epub 2024 Dec 19.
American Thyroid Association guidelines support active surveillance (AS) for low-risk papillary thyroid cancer (PTC). We developed a calculator to aid patient selection.
From 2004 to 2020, 148,904 PTC patients were selected from the surveillance, epidemiology, and end results (SEER) database. Univariable and multivariable analysis evaluated patient and treatment characteristics. Patients were randomly allocated into training (80%) or validation sets (20%). Coefficients generated a mathematical model to predict 5- and 10-year disease-specific survival (DSS).
The mean DSS was 15.5 years with a 5- and 10-year DSS of 99.3% and 98.6%, respectively. Age, sex, race, median household income (MHI), tumor size, and nodal status were significant on multivariable analysis (p ≤ 0.05) and included variables in our calculator. 2404 patients underwent non-operative management (NOM) and were more likely older, male, higher MHI, larger tumor size, and less nodal positivity. Area under the curve (AUC) for 5- and 10-year DSS were 0.83 and 0.81, respectively, for the training set and 0.81 and 0.79, respectively, for the validation set.
65-year-old White female with a 0.8 cm PTC, cN0 with a MHI ≥ $75,000, had a 10-year predicted DSS was 95.6% with NOM and 99.3% with surgery. Alternatively, changing the patient's race to Hispanic, the 10-year predicted DSS was 94.1% with NOM and 99.0% with surgery.
As awareness of AS for PTC expands, it is important to consider objective data to guide informed decision making. This validated calculator is a useful tool to predict DSS for patients considering AS for PTC.
美国甲状腺协会指南支持对低风险甲状腺乳头状癌（PTC）进行主动监测（AS）。我们开发了一种计算器来辅助患者选择。
从2004年到2020年，从监测、流行病学和最终结果（SEER）数据库中选取了148,904例PTC患者。单变量和多变量分析评估了患者和治疗特征。患者被随机分配到训练集（80%）或验证集（20%）。系数生成了一个数学模型来预测5年和10年疾病特异性生存率（DSS）。
平均DSS为15.5年，5年和10年DSS分别为99.3%和98.6%。年龄、性别、种族、家庭收入中位数（MHI）、肿瘤大小和淋巴结状态在多变量分析中具有显著性（p≤0.05），并纳入了我们计算器中的变量。2404例患者接受了非手术治疗（NOM），他们更可能年龄较大、为男性、MHI较高、肿瘤较大且淋巴结阳性率较低。训练集5年和10年DSS的曲线下面积（AUC）分别为0.83和0.81，验证集分别为0.81和0.79。
一名65岁白人女性，患有0.8 cm的PTC，cN0，MHI≥75,000美元，其10年预测DSS采用NOM为95.6%，采用手术为99.3%。或者，将患者种族改为西班牙裔，10年预测DSS采用NOM为94.1%，采用手术为99.0%。
随着对PTC进行AS的认知度扩大，考虑客观数据以指导明智决策很重要。这个经过验证的计算器是预测考虑对PTC进行AS的患者DSS的有用工具。
