Ma Jiaojiao, Wang Xi, Wang Shanshan, Yu Xuejiao, Li Yang, Sun Zhe, Li Huilin, Cheng Yong, Zhang Bo
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China.
Transl Cancer Res. 2025 Aug 31;14(8):5127-5141. doi: 10.21037/tcr-2025-1617. Epub 2025 Aug 28.
Despite thyroid cancer's favorable prognosis, population-level data on suicide risk and predictive factors remain limited, necessitating targeted mental health interventions. Patients experience significant psychological distress due to diagnostic/treatment uncertainties, particularly in the active surveillance era. This study quantified suicide mortality and identified risk predictors among US thyroid cancer patients.
We analyzed 328,264 histologically confirmed thyroid cancer patients [International Classification of Diseases for Oncology (ICD-O) C73.9] from the Surveillance, Epidemiology and End Results (SEER) database (2000-2021). Exclusions: non-suicide deaths, cases without microscopic confirmation, and incomplete records. We calculated standardized mortality ratios (SMRs) versus the general population and analyzed demographic (age, sex, race, income) and clinical predictors (stage, treatment history, tumor sequence) using Cox regression. A nomogram was developed from significant predictors and internally validated.
Among 328,264 patients (75.3% female; median age 48 years), 282 died by suicide, yielding an SMR of 1.24 [95% confidence interval (CI): 0.72-1.99]. Key high-risk subgroups included males [hazard ratio (HR) =1.93], patients aged 10-39 years, and those diagnosed between 2016-2020 (HR =6.17). The nomogram demonstrated good predictive accuracy, with a C-index of 0.795.
Thyroid cancer patients show elevated suicide risk, particularly young males and recent diagnoses. While the nomogram may help identify high-risk subgroups, its clinical utility requires external validation and integration with psychosocial assessments.
尽管甲状腺癌预后良好，但关于自杀风险和预测因素的人群水平数据仍然有限，因此需要有针对性的心理健康干预措施。患者因诊断/治疗的不确定性而经历显著的心理困扰，尤其是在主动监测时代。本研究对美国甲状腺癌患者的自杀死亡率进行了量化，并确定了风险预测因素。
我们分析了监测、流行病学和最终结果（SEER）数据库（2000 - 2021年）中328264例经组织学确诊的甲状腺癌患者[国际肿瘤疾病分类（ICD - O）C73.9]。排除标准：非自杀死亡、未经显微镜确认的病例以及记录不完整的病例。我们计算了相对于一般人群的标准化死亡率（SMR），并使用Cox回归分析了人口统计学因素（年龄、性别、种族、收入）和临床预测因素（分期、治疗史、肿瘤顺序）。根据显著预测因素制定了列线图并进行了内部验证。
在328264例患者中（75.3%为女性；中位年龄48岁），282例死于自杀，标准化死亡率为1.24[95%置信区间（CI）：0.72 - 1.99]。主要的高风险亚组包括男性[风险比（HR） = 1.93]、10 - 39岁的患者以及2016 - 2020年间确诊的患者（HR = 6.17）。列线图显示出良好的预测准确性，C指数为0.795。
甲状腺癌患者的自杀风险升高，尤其是年轻男性和近期确诊的患者。虽然列线图可能有助于识别高风险亚组，但其临床实用性需要外部验证并与社会心理评估相结合。
