Nomograms for Differentiated Thyroid Carcinoma Patients Based on the Eighth AJCC Staging and Competing-Risks Model
Menée à partir de données des registres américains des cancers portant sur 34 585 patients atteints d'un carcinome différencié de la thyroïde, cette étude évalue la performance d'un nomogramme, basé sur des paramètres de la 8ème édition du système de stadification de l'"American Joint Committee On Cancer", pour prédire le risque de décès lié à la maladie ou à d'autres causes
Background : Differentiated thyroid carcinoma (DTC) patients have a long survival period and good prognosis, so they are easily affected by competing risk events. The purpose of this study was to use the competing-risks model to identify prognostic factors for cause-specific death (CSD) and death due to other causes (DOC) in patients with DTC.
Methods : Our screening process identified 34,585 DTC patients in SEER database and randomly divided them into a training cohort and a validation cohort. We used the Fine and Gray subdistribution hazards model to establish the CSD and DOC nomograms. The distinguishing ability and consistency of the nomograms were evaluated using the C-indexes and calibration plots.
Results : Our analysis of a competing-risks model revealed that pathological grade, tumor size, histological type, AJCC-8 stage, surgery status, adjuvant radiotherapy status, adjuvant chemotherapy status, and log odds of positive lymph nodes are prognostic factors for CSD; while age at diagnosis, year of diagnosis, sex, pathological grade, tumor size, AJCC-8 stage, surgery status, adjuvant radiotherapy status, and lymph node ratio are prognostic factors for DOC. The 1-year, 3-year and 5-year concordance indexes in the validation cohorts were 0.942, 0.931 and 0.913 for the CSD nomogram and 0.813, 0.746 and 0.776 for the DOC nomogram. The calibration plots showed good consistency in both nomograms.
Conclusions : Our nomograms can be used as a tool to help clinicians to individually predict the probability of CSD and DOC in DTC patients at 1-year, 3-year and 5-year, which has certain guiding value in clinical applications.
JNCI Cancer Spectrum , article en libre accès, 2020