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Abstract：
Medullary thyroid carcinoma (MTC) is an infrequent form malignant tumor with a poor prognosis. Because of the influence of competitive risk, there may suffer from bias in the analysis of prognostic factors of MTC.
By extracting the data of patients diagnosed with MTC registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1998 to 2016, we established the Cox proportional-hazards and competing-risks model to retrospectively analyze the impact of related factors on lymph nodes statistically.
A total of 2,435 patients were included in the analysis, of which 198 died of MTC. The results of the multifactor competing-risk model showed that the number of total lymph nodes (19-89), positive lymph nodes (1-10,11-75) and positive lymph node ratio (25%-53%,>54%), age (46-60,>61), chemotherapy, mode of radiotherapy (others), tumor size(2-4cm,>4cm), number of lesions greater than 1 were poor prognostic factors for MTC. For the number of total lymph nodes, unlike the multivariate Cox proportional-hazards model results, we found that it became an independent risk factor after excluding competitive risk factors. Competitive risk factors have little effect on the number of positive lymph nodes. For the proportion of positive lymph nodes, we found that after excluding competitive risk factors, the Cox proportional-hazards model overestimates its impact on prognosis. The competitive risk model is often more accurate in analyzing the effects of prognostic factors.
After excluding the competitive risk, the number of lymph nodes, the number of positive and the positive proportion are the poor prognostic factors of medullary thyroid cancer, which can help clinicians more accurately evaluate the prognosis of patients with medullary thyroid cancer and provide a reference for treatment decision-making.
By extracting the data of patients diagnosed with MTC registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1998 to 2016, we established the Cox proportional-hazards and competing-risks model to retrospectively analyze the impact of related factors on lymph nodes statistically.
A total of 2,435 patients were included in the analysis, of which 198 died of MTC. The results of the multifactor competing-risk model showed that the number of total lymph nodes (19-89), positive lymph nodes (1-10,11-75) and positive lymph node ratio (25%-53%,>54%), age (46-60,>61), chemotherapy, mode of radiotherapy (others), tumor size(2-4cm,>4cm), number of lesions greater than 1 were poor prognostic factors for MTC. For the number of total lymph nodes, unlike the multivariate Cox proportional-hazards model results, we found that it became an independent risk factor after excluding competitive risk factors. Competitive risk factors have little effect on the number of positive lymph nodes. For the proportion of positive lymph nodes, we found that after excluding competitive risk factors, the Cox proportional-hazards model overestimates its impact on prognosis. The competitive risk model is often more accurate in analyzing the effects of prognostic factors.
After excluding the competitive risk, the number of lymph nodes, the number of positive and the positive proportion are the poor prognostic factors of medullary thyroid cancer, which can help clinicians more accurately evaluate the prognosis of patients with medullary thyroid cancer and provide a reference for treatment decision-making.
摘要：
背景：甲状腺髓样癌（MTC）是一种罕见的恶性肿瘤，预后不良。由于竞争风险的影响,MTC预后因素分析可能存在偏倚。
方法：通过提取监测中登记的MTC诊断患者的数据，流行病学,在1998年至2016年的最终结果（SEER）数据库中，我们建立了Cox比例风险和竞争风险模型，回顾性分析了相关因素对淋巴结的影响。
结果：共有2,435名患者被纳入分析，其中198人死于MTC。多因素竞争风险模型的结果表明，总淋巴结数（19-89），阳性淋巴结（1-10，11-75）和阳性淋巴结比率（25％-53％，>54%），年龄（46-60，>61），化疗,放疗模式（其他），肿瘤大小(2-4cm,>4cm)，病灶数大于1是MTC的不良预后因素.对于总淋巴结数，与多元Cox比例风险模型的结果不同，我们发现，在排除竞争性风险因素后，它成为独立的风险因素。竞争性危险因素对阳性淋巴结数量影响不大。对于阳性淋巴结的比例，我们发现，在排除竞争风险因素后，Cox比例风险模型高估了其对预后的影响。竞争风险模型在分析预后因素的影响时通常更准确。
结论：排除竞争风险后，淋巴结的数量，阳性数量和阳性比例是甲状腺髓样癌的不良预后因素,有助于临床医生更准确地评估甲状腺髓样癌患者的预后,为治疗决策提供参考依据。
方法：通过提取监测中登记的MTC诊断患者的数据，流行病学,在1998年至2016年的最终结果（SEER）数据库中，我们建立了Cox比例风险和竞争风险模型，回顾性分析了相关因素对淋巴结的影响。
结果：共有2,435名患者被纳入分析，其中198人死于MTC。多因素竞争风险模型的结果表明，总淋巴结数（19-89），阳性淋巴结（1-10，11-75）和阳性淋巴结比率（25％-53％，>54%），年龄（46-60，>61），化疗,放疗模式（其他），肿瘤大小(2-4cm,>4cm)，病灶数大于1是MTC的不良预后因素.对于总淋巴结数，与多元Cox比例风险模型的结果不同，我们发现，在排除竞争性风险因素后，它成为独立的风险因素。竞争性危险因素对阳性淋巴结数量影响不大。对于阳性淋巴结的比例，我们发现，在排除竞争风险因素后，Cox比例风险模型高估了其对预后的影响。竞争风险模型在分析预后因素的影响时通常更准确。
结论：排除竞争风险后，淋巴结的数量，阳性数量和阳性比例是甲状腺髓样癌的不良预后因素,有助于临床医生更准确地评估甲状腺髓样癌患者的预后,为治疗决策提供参考依据。
