Nomogram for the Prediction of Biochemical Incomplete Response in Papillary Thyroid Cancer Patients

Abstract

Purpose: To develop a nomogram for predicting biochemical incomplete response (BIR) in the dynamic risk stratification (DRS) of papillary thyroid carcinoma (PTC) patients without structural recurrence, and to investigate its validity. Patients and Methods: Overall, 1705 (1005 and 700 in the training and validation cohorts, respectively) PTC patients treated with total thyroidectomy without structural recurrence were included. multivariate logistic regression analyses were performed to determine the significant predictors of BIR in the training cohort. A nomogram was subsequently constructed for BIR risk prediction. Assessments for the predictive accuracy, discrimination, and calibration of the nomogram were performed. Subsequently, internal and external validations were conducted. Results: In the multivariate analysis, age, sex, lymph node metastasis site, extrathyroidal extension, and lymphovascular invasion showed significant predictive value; using these predictive factors and tumor size, a nomogram for BIR risk prediction was constructed. In the training cohort, the nomogram showed good predictive performance and discrimination in the receiver operating characteristic (ROC) curve analysis, with an area under the curve (AUC) of 0.765. In internal validation, the bootstrap-corrected AUC was 0.76. The calibration plot showed good agreement between the predicted and actual observation. The Hosmer-Lemeshow (HL) test did not suggest a lack of fit (p=0.1613). In the external validation, the AUC was 0.828 in the ROC curve analysis; the calibration plot showed good quality, and the HL test did not suggest a lack of fit (p=0.2161). Conclusion:The constructed nomogram may effectively predict the risk of BIR in DRS in PTC patients without structural recurrence. Level of Evidence: Level 4.

Prognostic factors for postoperative papillary thyroid cancer with unexplained elevated Tg: A retrospective study

“…After adjusting for confounding factors, multivariate analysis demonstrated that only N stage and TNM stage were independent risk factors for RFS. Given that it has been reported that N1b increased the risk of recurrence and death in DTC patients [ [14] , [15] , [16] , [17] ] and N1b was independently identified as a predictor of an unfavorable response to 131 I therapy [ 18 ]. Our study also showed that the RFS rate in the N1b group was significantly lower than that in the N0/N1a group, with a hazard ratio of 2.749.…”

Clinical outcome and influencing factors for postoperative papillary thyroid cancer with unexplained elevated Tg prior 131I therapy

“…The results showed that N stage was an independent factor for predicting SIR, while the sup-Tg level 6 months post RAT was an independent predictor of IR. Since it has been reported that N1b increased the risk of recurrence and death in DTC patients [19][20][21][22] and N1b was con rmed to be an independent factor predicting unfavorable response to 131 I therapy [23]. Thus, for unexplained elevated Tg with N1b the degree of TSH suppression should be adjusted appropriately and intensive follow-up should be conducted to detect recurrence and metastasis as early as possible.…”

Establishment and validation of a nomogram to predict structural incomplete response in papillary thyroid carcinoma patients: a retrospective study

“…The other article only predicted incomplete biochemical response in patients but without structural recurrence after total thyroidectomy. 14 Among these models, only three pieces included sonographic features, which predicted PTC diagnosis, but no recurrence.…”