Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지

Clinical Prognostic Score for Predicting Disease Remission with Differentiated Thyroid Cancers

  • Somboonporn, Charoonsak (Department of Radiology, Faculty of Medicine, Khon Kaen University) ;
  • Mangklabruks, Ampica (Department of Internal Medicine, Faculty of Medicine, Chiang Mai University) ;
  • Thakkinstian, Ammarin (Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University) ;
  • Vatanasapt, Patravoot (Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University) ;
  • Nakaphun, Suwannee (Nuclear Medicine Division, Maharat Nakhon Ratchasima Hospital, Maharat Nakhon Ratchasima)
  • Published : 2016.06.01
⟨ Previous Next ⟩

Abstract

Background: Differentiated thyroid cancer is the most common endocrine malignancy with a generally good prognosis. Knowing long-term outcomes of each patient helps management planning. The study was conducted to develop and validate a clinical prognostic score for predicting disease remission in patients with differentiated thyroid cancer based on patient, tumor and treatment factors. Materials and Methods: A retrospective cohort study of 1,217 differentiated thyroid cancer patients from two tertiary-care hospitals in the Northeast of Thailand was performed. Associations between potential clinical prognostic factors and remission were tested by Cox proportional-hazards analysis in 852 patients (development cohort). The prediction score was created by summation of score points weighted from regression coefficients of independent prognostic factors. Risks of disease remission were estimated and the derived score was then validated in the remaining 365 patients (validation cohort). Results: During the median follow-up time of 58 months, 648 (76.1%) patients in the development cohort had disease remission. Five independent prognostic factors were identified with corresponding score points: duration from thyroid surgery to $^{131}I$ treatment (0.721), distant metastasis at initial diagnosis (0.801), postoperative serum thyroglobulin level (0.535), anti-thyroglobulin antibodies positivity (0.546), and adequacy of serum TSH suppression (0.293). The total risk score for each patient was calculated and three categories of remission probability were proposed: ${\leq}1.628$ points (low risk, 83% remission), 1.629-1.816 points (intermediate risk, 87% remission), and ${\geq}1.817$ points (high risk, 93% remission). The concordance (C-index) was 0.761 (95% CI 0.754-0.767). Conclusions: The clinical prognostic scoring model developed to quantify the probability of disease remission can serve as a useful tool in personalized decision making regarding treatment in differentiated thyroid cancer patients.

Keywords

Acknowledgement

Supported by : Khon Kaen University

References

  1. van Buuren S, Boshuizen HC, Knook DL (1999). Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med, 18, 681-94. https://doi.org/10.1002/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R
  2. Cooper DS, Doherty GM, Haugen BR, et al (2006). Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. the american thyroid association guidelines taskforce. Thyroid, 16, 109-41. https://doi.org/10.1089/thy.2006.16.109
  3. Cooper DS, Doherty GM, Haugen BR, et al (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19, 1167-214. https://doi.org/10.1089/thy.2009.0110
  4. DeGroot LJ, Kaplan EL, McCormick M, Straus FH (1990). Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab, 71, 414-24. https://doi.org/10.1210/jcem-71-2-414
  5. Edge SB, Compton CC (2010). The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 17, 1471-4. https://doi.org/10.1245/s10434-010-0985-4
  6. Fatima N, uz Zaman M, Ikram M, et al (2014). Baseline stimulated thyroglobulin level as a good predictor of successful ablation after adjuvant radioiodine treatment for differentiated thyroid cancers. Asian Pac J Cancer Prev, 15, 6443-7. https://doi.org/10.7314/APJCP.2014.15.15.6443
  7. Garg A, Chopra S, Ballal S, Soundararajan R, Bal CS (2015). Differentiated thyroid cancer in patients over 60 years of age at presentation: a retrospective study of 438 patients. J Geriatr Oncol, 6, 29-37. https://doi.org/10.1016/j.jgo.2014.09.182
  8. Haugen BR, Alexander EK, Bible KC, et al (2016). 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 26, 1-133. https://doi.org/10.1089/thy.2015.0020
  9. Hundahl SA, Flemming ID, Fremgen AM, Menck HR (1998). A national cancer data base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer, 83, 2638-48. https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12<2638::AID-CNCR31>3.0.CO;2-1
  10. La Vecchia C, Malvezzi M, Bosetti C, et al (2015). Thyroid cancer mortality and incidence: a global overview. Int J Cancer, 136, 2187-95. https://doi.org/10.1002/ijc.29251
  11. Latrofa F, Ricci D, Montanelli L, et al (2012). Lymphocytic thyroiditis on histology correlates with serum thyroglobulin autoantibodies in patients with papillary thyroid carcinoma: impact on detection of serum thyroglobulin. J Clin Endocrinol Metab, 97, 2380-7. https://doi.org/10.1210/jc.2011-2812
  12. Loyo M, Tufano RP, Gourin CG (2013). National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope, 123, 2056-63. https://doi.org/10.1002/lary.23923
  13. Mazzaferri EL (2005). An overview of follow-up of differentiated thyroid cancer. In 'Essentials of thyroid cancer management', Eds Amdur RJ and Mazzaferri EL. Springer Science+Business Media, New York pp 297-301.
  14. Mazzaferri EL, Kloos RT (2001). Current approaches to primary therapy of papillary and follicular thyroid cancer. J Clin Endocrinol Metab, 86, 1447-63. https://doi.org/10.1210/jcem.86.4.7407
  15. Pencina MJ, D'Agostino RB (2004). Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med, 23, 2109-23. https://doi.org/10.1002/sim.1802
  16. Raef H, Alfadhli E, Al-Hajjaj A, et al (2008). High rate of persistent/recurrent disease among patients with differentiated thyroid cancer in Saudi Arabia: factors affecting nonremission. Ann Saudi Med, 28, 277-81. https://doi.org/10.4103/0256-4947.51707
  17. Rubin DB, Schenker N (1991). Multiple imputation in healthcare databases: an overview and some applications. Stat Med, 10, 585-98. https://doi.org/10.1002/sim.4780100410
  18. Samaan NA, Schultz PN, Hickey RC, et al (1992). The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab, 75, 714-20.
  19. Singer PA, Cooper DS, Daniels GH, et al (1996). Treatment guidelines for patients with thyroid nodules and welldifferentiated thyroid cancer. American Thyroid Association. Arch Intern Med, 28, 2165-72.
  20. Spencer CA, LoPresti JS, Fatemi S, Nicoloff JT (1999). Detection of residual and recurrent differentiated thyroid carcinoma by serum thyroglobulin measurement. Thyroid, 9, 435-41. https://doi.org/10.1089/thy.1999.9.435
  21. Sriplung H, Sontipong S, Martin N, et al (2005). Cancer incidence in Thailand, 1995-1997. Asian Pac J Cancer Prev, 6, 276-81.
  22. Sundram F, Robinson BG, Kung A, et al (2006). Welldifferentiated epithelial thyroid cancer management in the Asia Pacific region: a report and clinical practice guideline. Thyroid, 16, 461-9. https://doi.org/10.1089/thy.2006.16.461
  23. Thamnirat K, Utamakul C, Chamroonrat W, et al (2015). Factors affecting disease-free status of differentiated thyroid carcinoma patients. Asian Pac J Cancer Prev, 16, 737-40. https://doi.org/10.7314/APJCP.2015.16.2.737
  24. Vergouwe Y, Royston P, Moons KG, Altman DG (2010). Development and validation of a prediction model with missing predictor data: a practical approach. J Clin Epidemiol, 63, 205-14. https://doi.org/10.1016/j.jclinepi.2009.03.017
  25. Welsch M, Abeln M, Zaplatnikov K, et al (2007). Multiparameter scoring system for the prognosis of differentiated thyroid cancer. Nuklearmedizin, 46, 257-62.
  26. White IR, Royston P, Wood AM (2011). Multiple imputation using chained equations: Issues and guidance for practice. Stat Med, 30, 377-99. https://doi.org/10.1002/sim.4067
  27. Yildirim E (2005). A model for predicting outcomes in patients with differentiated thyroid cancer and model performance in comparison with other classification systems. J Am Coll Surg, 200, 378-92. https://doi.org/10.1016/j.jamcollsurg.2004.10.031