PDF(Pubmed)
Abstract：
BACKGROUND: According to the latest classification of thyroid tumors released by the WHO in 2022, primary squamous cell carcinoma of the thyroid (PSCCTh) is classified as anaplastic thyroid carcinoma (ATC). The objective of this study was to determine the differences in characteristics between ATC and PSCCTh and develop a nomogram to predict overall survival patients with the redefined anaplastic thyroid carcinoma (rATC).
METHODS: Patients diagnosed with ATC and PSCCTh between 2000 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database were enrolled and randomly divided into a training cohort and a validation cohort with a ratio of 7:3. Overall survival (OS) and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method and compared using log-rank tests. The univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors of rATC patients. We then developed and validated nomograms to predict the 3-, 6- and 12-month OS of rATC and the results were evaluated by C-index and calibration curves.
RESULTS: After application of the inclusion and exclusion criteria, a total of 1338 ATC and 127 PSCCTh patients were included in the study. Further, OS and CSS of patients with PSCCTh were better than that of patients with ATC. Prognostic factors were not identical for the two cancers. Multivariate Cox model analysis indicated that age, tumor size, metastasis, surgery, radiotherapy, chemotherapy are independent prognostic factors for CSS in patients with ATC; while for patients with PSCCTh, the corresponding factors are age, and surgery. We selected six survival predictors (age, tumor size, metastasis, surgery, radiation, and, chemotherapy) for nomogram construction. The C-indexes in the training and validation cohort were 0.740 and 0.778, respectively, reflecting the good discrimination ability of the model. The calibration curves also showed good consistency in the probability of 3-, 6-, and 12-month OS between the actual observation and the nomogram prediction.
CONCLUSIONS: We constructed a nomogram to provide a convenient and reliable tool for predicting OS in rATC patients. Prognostic factors influencing CSS were not identical in patients with ATC and PSCCTh. These findings indicate that different clinical treatment and management plans are required for patients with these two types of thyroid cancer.
METHODS: Patients diagnosed with ATC and PSCCTh between 2000 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database were enrolled and randomly divided into a training cohort and a validation cohort with a ratio of 7:3. Overall survival (OS) and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method and compared using log-rank tests. The univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors of rATC patients. We then developed and validated nomograms to predict the 3-, 6- and 12-month OS of rATC and the results were evaluated by C-index and calibration curves.
RESULTS: After application of the inclusion and exclusion criteria, a total of 1338 ATC and 127 PSCCTh patients were included in the study. Further, OS and CSS of patients with PSCCTh were better than that of patients with ATC. Prognostic factors were not identical for the two cancers. Multivariate Cox model analysis indicated that age, tumor size, metastasis, surgery, radiotherapy, chemotherapy are independent prognostic factors for CSS in patients with ATC; while for patients with PSCCTh, the corresponding factors are age, and surgery. We selected six survival predictors (age, tumor size, metastasis, surgery, radiation, and, chemotherapy) for nomogram construction. The C-indexes in the training and validation cohort were 0.740 and 0.778, respectively, reflecting the good discrimination ability of the model. The calibration curves also showed good consistency in the probability of 3-, 6-, and 12-month OS between the actual observation and the nomogram prediction.
CONCLUSIONS: We constructed a nomogram to provide a convenient and reliable tool for predicting OS in rATC patients. Prognostic factors influencing CSS were not identical in patients with ATC and PSCCTh. These findings indicate that different clinical treatment and management plans are required for patients with these two types of thyroid cancer.
摘要：
背景：根据WHO在2022年发布的最新甲状腺肿瘤分类，原发性甲状腺鳞状细胞癌（PSCCTh）被归类为甲状腺未分化癌（ATC）。这项研究的目的是确定ATC和PSCCTh之间特征的差异，并开发列线图来预测重新定义的间变性甲状腺癌（rATC）患者的总体生存率。
方法：从监测中诊断为ATC和PSCCTh的患者在2000年至2018年之间，流行病学,和最终结果（SEER）数据库被纳入并随机分为训练队列和验证队列，比例为7:3。使用Kaplan-Meier方法估计总生存期（OS）和癌症特异性生存期（CSS），并使用对数秩检验进行比较。单因素和多因素Cox比例风险回归分析用于确定rATC患者的独立预后因素。然后，我们开发并验证了列线图来预测3-，通过C指数和校准曲线评估rATC的6个月和12个月的OS和结果。
结果：应用纳入和排除标准后，本研究共纳入了1,38例ATC和127例PSCCTh患者.Further,PSCCTh患者的OS和CSS优于ATC患者。两种癌症的预后因素并不相同。多变量Cox模型分析表明，年龄，肿瘤大小,转移,手术,放射治疗,化疗是ATC患者CSS的独立预后因素；而对于PSCCTh患者，相应的因素是年龄，和手术。我们选择了六个生存预测因子(年龄，肿瘤大小,转移,手术,辐射,and,化疗)用于列线图构建。训练和验证队列中的C指数分别为0.740和0.778，反映了模型良好的判别能力。校准曲线在3-的概率中也显示出良好的一致性，6-，实际观测值和列线图预测值之间的12个月OS。
结论：我们构建了一个列线图，为预测rATC患者的OS提供了一个方便可靠的工具。在ATC和PSCCTh患者中，影响CSS的预后因素并不相同。这些结果表明，这两种类型的甲状腺癌患者需要不同的临床治疗和管理计划。
方法：从监测中诊断为ATC和PSCCTh的患者在2000年至2018年之间，流行病学,和最终结果（SEER）数据库被纳入并随机分为训练队列和验证队列，比例为7:3。使用Kaplan-Meier方法估计总生存期（OS）和癌症特异性生存期（CSS），并使用对数秩检验进行比较。单因素和多因素Cox比例风险回归分析用于确定rATC患者的独立预后因素。然后，我们开发并验证了列线图来预测3-，通过C指数和校准曲线评估rATC的6个月和12个月的OS和结果。
结果：应用纳入和排除标准后，本研究共纳入了1,38例ATC和127例PSCCTh患者.Further,PSCCTh患者的OS和CSS优于ATC患者。两种癌症的预后因素并不相同。多变量Cox模型分析表明，年龄，肿瘤大小,转移,手术,放射治疗,化疗是ATC患者CSS的独立预后因素；而对于PSCCTh患者，相应的因素是年龄，和手术。我们选择了六个生存预测因子(年龄，肿瘤大小,转移,手术,辐射,and,化疗)用于列线图构建。训练和验证队列中的C指数分别为0.740和0.778，反映了模型良好的判别能力。校准曲线在3-的概率中也显示出良好的一致性，6-，实际观测值和列线图预测值之间的12个月OS。
结论：我们构建了一个列线图，为预测rATC患者的OS提供了一个方便可靠的工具。在ATC和PSCCTh患者中，影响CSS的预后因素并不相同。这些结果表明，这两种类型的甲状腺癌患者需要不同的临床治疗和管理计划。
