Thyroglobulin measurement is the most powerful outcome predictor in differentiated thyroid cancer: a decision tree analysis in a European multicenter series.

IF 3.8 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY
Clinical chemistry and laboratory medicine Pub Date : 2024-05-07 Print Date: 2024-10-28 DOI:10.1515/cclm-2024-0405
Luca Giovanella, Lisa Milan, Wolfgang Roll, Manuel Weber, Simone Schenke, Michael Kreissl, Alexis Vrachimis, Kim Pabst, Tuncel Murat, Petra Petranović Ovčariček, Alfredo Campenni, Rainer Görges, Luca Ceriani
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引用次数: 0

Abstract

Objectives: An accurate prognostic assessment is pivotal to adequately inform and individualize follow-up and management of patients with differentiated thyroid cancer (DTC). We aimed to develop a predictive model for recurrent disease in DTC patients treated by surgery and 131I by adopting a decision tree model.

Methods: Age, sex, histology, T stage, N stage, risk classes, remnant estimation, thyroid-stimulating hormone (TSH), thyroglobulin (Tg), administered 131I activities and post-therapy whole body scintigraphy (PT-WBS) were identified as potential predictors and put into regression algorithm (conditional inference tree, c-tree) to develop a risk stratification model for predicting persistent/recurrent disease over time.

Results: The PT-WBS pattern identified a partition of the population into two subgroups (PT-WBS positive or negative for distant metastases). Patients with distant metastases exhibited lower disease-free survival (either structural, DFS-SD, and biochemical, DFS-BD, disease) compared to those without metastases. Meanwhile, the latter were further stratified into three risk subgroups based on their Tg values. Notably, Tg values >63.1 ng/mL predicted a shorter survival time, with increased DFS-SD for Tg values <63.1 and <8.9 ng/mL, respectively. A comparable model was generated for biochemical disease (BD), albeit different DFS were predicted by slightly different Tg cutoff values (41.2 and 8.8 ng/mL) compared to DFS-SD.

Conclusions: We developed a simple, accurate and reproducible decision tree model able to provide reliable information on the probability of structurally and/or biochemically persistent/relapsed DTC after a TTA. In turn, the provided information is highly relevant to refine the initial risk stratification, identify patients at higher risk of reduced structural and biochemical DFS, and modulate additional therapies and the relative follow-up.

甲状腺球蛋白测量是分化型甲状腺癌最有力的预后指标:欧洲多中心系列研究的决策树分析。
目的:准确的预后评估是为分化型甲状腺癌(DTC)患者的随访和管理提供充分信息并使之个体化的关键。我们的目的是通过决策树模型建立一个预测模型,用于预测接受手术和 131I 治疗的 DTC 患者的复发疾病:方法:将年龄、性别、组织学、T期、N期、风险分级、残余估计、促甲状腺激素(TSH)、甲状腺球蛋白(Tg)、131I活性和治疗后全身闪烁扫描(PT-WBS)作为潜在的预测因素,并将其纳入回归算法(条件推理树,c-tree),建立了一个风险分层模型,用于预测持续/复发疾病的时间:PT-WBS模式将人群划分为两个亚组(远处转移PT-WBS阳性或阴性)。与无远处转移的患者相比,有远处转移的患者无病生存期(结构性无病生存期(DFS-SD)和生化性无病生存期(DFS-BD))较低。同时,根据 Tg 值将后者进一步分为三个风险亚组。值得注意的是,Tg 值 >63.1 纳克/毫升预示着生存时间较短,Tg 值越高,DFS-SD 越高:我们开发了一种简单、准确且可重复的决策树模型,能够提供可靠的信息,说明 TTA 后 DTC 在结构上和/或生化上持续存在/复发的概率。反过来,所提供的信息对于完善初始风险分层、识别结构和生化 DFS 下降风险较高的患者、调整额外疗法和相对随访非常重要。
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来源期刊
Clinical chemistry and laboratory medicine
Clinical chemistry and laboratory medicine 医学-医学实验技术
CiteScore
11.30
自引率
16.20%
发文量
306
审稿时长
3 months
期刊介绍: Clinical Chemistry and Laboratory Medicine (CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor over 3. CCLM is issued monthly, and it is published in print and electronically. CCLM is the official journal of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and publishes regularly EFLM recommendations and news. CCLM is the official journal of the National Societies from Austria (ÖGLMKC); Belgium (RBSLM); Germany (DGKL); Hungary (MLDT); Ireland (ACBI); Italy (SIBioC); Portugal (SPML); and Slovenia (SZKK); and it is affiliated to AACB (Australia) and SFBC (France). Topics: - clinical biochemistry - clinical genomics and molecular biology - clinical haematology and coagulation - clinical immunology and autoimmunity - clinical microbiology - drug monitoring and analysis - evaluation of diagnostic biomarkers - disease-oriented topics (cardiovascular disease, cancer diagnostics, diabetes) - new reagents, instrumentation and technologies - new methodologies - reference materials and methods - reference values and decision limits - quality and safety in laboratory medicine - translational laboratory medicine - clinical metrology Follow @cclm_degruyter on Twitter!
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