Postoperative Nomogram for Predicting Cancer-Specific Mortality in Medullary Thyroid Cancer.

Abstract

BACKGROUND:

Medullary thyroid cancer (MTC) is a rare thyroid cancer accounting for 5 % of all thyroid malignancies. The purpose of our study was to design a predictive nomogram for cancer-specific mortality (CSM) utilizing clinical, pathological, and biochemical variables in patients with MTC.

METHODS:

MTC patients managed entirely at Memorial Sloan-Kettering Cancer Center between 1986 and 2010 were identified. Patient, tumor, and treatment characteristics were recorded, and variables predictive of CSM were identified by univariable analyses. A multivariable competing risk model was then built to predict the 10-year cancer specific mortality of MTC. All predictors of interest were added in the starting full model before selection, including age, gender, pre- and postoperative serum calcitonin, pre- and postoperative CEA, RET mutation status, perivascular invasion, margin status, pathologic T status, pathologic N status, and M status. Stepdown method was used in model selection to choose predictive variables.

RESULTS:

Of 249 MTC patients, 22.5 % (56/249) died from MTC, whereas 6.4 % (16/249) died secondary to other causes. Mean follow-up period was 87 ± 67 months. The seven variables with the highest predictive accuracy for cancer specific mortality included age, gender, postoperative calcitonin, perivascular invasion, pathologic T status, pathologic N status, and M status. These variables were used to create the final nomogram. Discrimination from the final nomogram was measured at 0.77 with appropriate calibration.

CONCLUSIONS:

We describe the first nomogram that estimates cause-specific mortality in individual patients with MTC. This predictive nomogram will facilitate patient counseling in terms of prognosis and subsequent clinical follow up.

• Authors: Allen S Ho, Lu Wang, Frank L Palmer, Changhong Yu, Arnbjorn Toset, Snehal Patel, Michael W Kattan, R Michael Tuttle, Ian Ganly
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 8 Pg. 2700-6 (Aug 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25366585 (Publication Type: Journal Article)

Chemical References

• Calcitonin

Topics

• Adult
• Age Factors
• Aged
• Blood Vessels (pathology)
• Calcitonin (blood)
• Carcinoma, Neuroendocrine (mortality, pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Lymphatic Metastasis
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Invasiveness
• Neoplasm Staging
• Nomograms
• Postoperative Period
• Predictive Value of Tests
• Sex Factors
• Survival Rate
• Thyroid Neoplasms (mortality, pathology, surgery)