Novel nomogram to predict risk of bone metastasis in newly diagnosed thyroid carcinoma : a population-based study
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RESEARCH ARTICLE
Open Access
Novel nomogram to predict risk of bone metastasis in newly diagnosed thyroid carcinoma: a population-based study Yuexin Tong1†, Chuan Hu1,2†, Zhangheng Huang1†, Zhiyi Fan1, Lujian Zhu3 and Youxin Song1*
Abstract Background: The aim of this study was to develop and validate a visual nomogram for predicting the risk of bone metastasis (BM) in newly diagnosed thyroid carcinoma (TC) patients. Methods: The demographics and clinicopathologic variables of TC patients from 2010 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively reviewed. Chi-squared (χ2) test and logistic regression analysis were performed to identify independent risk factors. Based on that, a predictive nomogram was developed and validated for predicting the risk of BM in TC patients. The C-index was used to compute the predictive performance of the nomogram. Calibration curves and decision curve analysis (DCA) were furthermore used to evaluate the clinical value of the nomogram. Results: According to the inclusion and exclusion criteria, the data of 14,772 patients were used to analyze in our study. After statistical analysis, TC patients with older age, higher T stage, higher N stage, poorly differentiated, follicular thyroid carcinoma (FTC) and black people had a higher risk of BM. We further developed a nomogram with a C-index of 0.925 (95%CI,0.895–0.948) in the training set and 0.842 (95%CI,0.777–0.907) in the validation set. The calibration curves and decision curve analysis (DCA) also demonstrated the reliability and accuracy of the clinical prediction model. Conclusions: The present study developed a visual nomogram to accurately identify TC patients with high risk of BM, which might help to further provide more individualized clinical decision guidelines. Keywords: Thyroid carcinoma, bone, metastasis, risk factors, Nomogram, SEER database
Background Thyroid carcinoma (TC) is the most common type of endocrine malignancy, for which incidence has grown rapidly worldwide during the past few decades [1, 2]. Owing to biological characteristics and effective therapeutic responses, TC has a favorable long-term prognosis, with an average 10-year overall survival of approximately 90% [3, 4]. However, the * Correspondence: [email protected] † Yuexin Tong, Chuan Hu and Zhangheng Huang contributed equally to this work. 1 Department of Orthopedic, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi St, Chengde 067000, Hebei, China Full list of author information is available at the end of the article
overall prognosis worsens significantly once patients develop distant metastasis (DM), as the 10-year survival drops to 40% [5–7]. Even more noteworthy, approximately 70% of TC patients with DM die within four years of diagnosis [8]. Bone metastasis (BM) is a typical metastatic pattern for TC patients. It was reported that BM occur in about 4% of all TC patients [9], and the 5- and 10-year survival rates of TC patients with BM are 61 and 27%, respectively [10]. The majority
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