Abstract
Background Medullary thyroid carcinoma (MTC) accounts for 1%–2% of thyroid cancer in the United States based on the latest Surveillance, Epidemiology, and End Results (SEER) data, and this study aimed to construct a comprehensive predictive nomogram based on various clinical variables in MTC patients who underwent total thyroidectomy and neck lymph nodes dissection. Methods Data regarding 1,237 MTC patients who underwent total thyroidectomy and neck lymph nodes dissection from 2004 to 2015 were obtained from the SEER database. Univariate and multivariate Cox regression analyses were used to screen for meaningful independent predictors. These independent factors were used to construct a nomogram model, a survival prognostication tool for 3- and 5-year overall survival, and cancer-specific survival among these MTC patients. Result A total of 1,237 patients enrolled from the SEER database were randomly divided into the training group (n = 867) and the test group (n = 370). Univariate and multivariate Cox regression analyses were used to identify meaningful independent prognostic factors (P < 0.05). Tumor size, age, metastasis status, and LNR were selected as independent predictors of overall survival (OS) and cancer-specific survival (CSS). Finally, two nomograms were developed, and the predicted C-index of overall survival (OS) and cancer-specific survival (CSS) rate in the training group was 0.828 and 0.904, respectively. The predicted C-index of overall survival (OS) and cancer-specific survival (CSS) rate in the test group was 0.813 and 0.828. Conclusion Nomograms constructed by using various clinical variables can make more comprehensive and accurate predictions for MTC patients who underwent total thyroidectomy and neck lymph nodes. These predictive nomograms help identify postoperative high-risk MTC patients and facilitate patient counseling on clinical prognosis and follow-up.
Highlights
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignant tumor derived from parafollicular cells, accounting for 1%–2% of thyroid cancer in the United States based on the latest Surveillance, Epidemiology, and End Results (SEER) data [1]. 25% of MTCs are of hereditary origin, which is related to the RET proto-oncogene, most occurs as part of multiple endocrine neoplasia (MEN) 2 syndrome, and the remaining occur as sporadic forms [2]
MTC accounts for 14% of all thyroid cancer-related deaths, and the 10-year survival rate of patients whose tumors are limited to the glands is 95.6%, its 10-year survival rate drops to 75.5% when cervical lymph node metastasis exists; patients with distant metastases had the worst prognosis and only 40% of patients can survive for 10 years [3]. e current prognosis evaluation depends on the American Cancer Society (AJCC) TNM staging system, of which other variables that may be significant for determining the outcome of individual patients are not considered
Patients and Data Collection. e data were extracted from the SEER database using the SEER∗Stat software. e patients were limited to being diagnosed with MTC and underwent total thyroidectomy and neck lymph nodes dissection between January 1, 2004, and December 31, 2015
Summary
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignant tumor derived from parafollicular cells, accounting for 1%–2% of thyroid cancer in the United States based on the latest Surveillance, Epidemiology, and End Results (SEER) data [1]. 25% of MTCs are of hereditary origin, which is related to the RET proto-oncogene, most occurs as part of multiple endocrine neoplasia (MEN) 2 syndrome, and the remaining occur as sporadic forms [2].e guidelines of the National Comprehensive Cancer Network (NCCN) and the American yroid Association (ATA) recommend total thyroidectomy and varied levels of lymphadenectomy for MTC patients. We assessed MTC patients who underwent total thyroidectomy and neck lymph nodes dissection registered between 2004 and 2015 in the SEER database and developed validated nomograms for overall survival (OS) and cancer-specific survival (CSS) of MTC patients. Medullary thyroid carcinoma (MTC) accounts for 1%–2% of thyroid cancer in the United States based on the latest Surveillance, Epidemiology, and End Results (SEER) data, and this study aimed to construct a comprehensive predictive nomogram based on various clinical variables in MTC patients who underwent total thyroidectomy and neck lymph nodes dissection. Data regarding 1,237 MTC patients who underwent total thyroidectomy and neck lymph nodes dissection from 2004 to 2015 were obtained from the SEER database. Nomograms constructed by using various clinical variables can make more comprehensive and accurate predictions for MTC patients who underwent total thyroidectomy and neck lymph nodes
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