A model for predicting outcomes in patients with differentiated thyroid cancer and model performance in comparison with other classification systems

Abstract

This study was performed to determine the prognostic factors for differentiated thyroid cancer, and to establish a mathematical prognostic model. A retrospective study was conducted in 347 differentiated thyroid cancer patients. Univariate and multivariate prognostic factor analyses were carried out using the Kaplan-Meier and Cox regression methods. Without adjustment for treatment in the multivariate analysis, age, tumor size, angioinvasion, and distant metastasis were significant predictors of outcomes. The very low-risk, low-risk, high-risk, and very high-risk groups were identified from the logistic regression equation. Overall and event-free survival estimations at 10 years were 100% and 100% for very low-risk patients, 88% and 75% for low-risk patients, 30% and 16% for high-risk patients, and 5% and 0% for very high-risk patients. Inclusion of treatment in the multivariate analysis showed, in addition to other variables, that both total or near total thyroidectomy (versus thyroidectomy less than total and near total thyroidectomy, p = 0.0002; hazard ratio, 0.4; 95% CI, 0.3-0.7) and adjuvant radioactive iodine treatment (versus no treatment with radioactive iodine, p = 0.0001; hazard ratio, 0.5; 95% CI, 0.2-0.8) were associated with a reduced hazard of death in the followup period. By subgroup analysis, total and near total thyroidectomy, along with radioactive iodine, appeared to provide a survival benefit for all patients except those in the very low-risk group. The proposed mathematical model is satisfactory for predicting outcomes. Total and near total thyroidectomy along with radioactive iodine treatment might provide a survival advantage for differentiated thyroid cancer, except for those with very low risk.