Postoperative nomogram for predicting cancer-specific mortality in medullary thyroid cancer Journal Article


Authors: Ho, A. S.; Wang, L.; Palmer, F. L.; Yu, C.; Toset, A.; Patel, S.; Kattan, M. W.; Tuttle, R. M.; Ganly, I.
Article Title: 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. © 2014, Society of Surgical Oncology.
Keywords: adult; middle aged; major clinical study; postoperative period; cancer patient; follow up; carcinoembryonic antigen; calibration; calcitonin; cancer mortality; cause of death; thyroidectomy; surgical mortality; disease specific survival; nomogram; patient counseling; model; predictive value; thyroid medullary carcinoma; calcitonin blood level; cancer prognosis; measurement accuracy; human; male; female; article
Journal Title: Annals of Surgical Oncology
Volume: 22
Issue: 8
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2015-08-01
Start Page: 2700
End Page: 2706
Language: English
DOI: 10.1245/s10434-014-4208-2
PROVIDER: scopus
PUBMED: 25366585
PMCID: PMC4986610
DOI/URL:
Notes: Export Date: 2 September 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Snehal G Patel
    305 Patel
  2. Robert M Tuttle
    374 Tuttle
  3. Ian Ganly
    261 Ganly
  4. Frank Palmer
    82 Palmer
  5. ArnBjorn Wollebaek Toset
    1 Toset