Application and subgroup analysis of competing risks model based on different lymph node staging systems in...

Area of Science:

• Endocrinology
• Oncology
• Medical Statistics

Background:

• Differentiated thyroid cancer (DTC) incidence is rising globally, necessitating improved prognostic tools.
• Accurate staging is crucial for effective patient management in DTC.
• Existing lymph node staging systems require evaluation for their prognostic efficacy in DTC.

Purpose of the Study:

• To evaluate the prognostic value of various lymph node staging systems in differentiated thyroid cancer.
• To compare the efficacy of positive lymph node numbers (PLNNs), metastatic lymph node ratio (MLNR), and log odds of positive lymph nodes (LODDS) in DTC prognosis.
• To identify the most suitable lymph node staging system for DTC, particularly in N1 stage disease.

Main Methods:

• Utilized the SEER database (1998-2016) with 16,527 DTC patient records.
• Employed a competing risks model for univariate and multivariate analyses.
• Assessed N stage, PLNNs, MLNR, LODDS, and LONT, including subgroup and ROC analyses.

Main Results:

• Different lymph node staging systems demonstrated varying prognostic correlations.
• Positive lymph node numbers (PLNNs) showed significant prognostic correlations across multiple subgroups.
• PLNNs proved more suitable than LODDS and MLNR for N1 stage DTC, with an optimal cut-off of 13.

Conclusions:

• Positive lymph node numbers (PLNNs) exhibit the highest prognostic discriminatory efficacy in differentiated thyroid cancer.
• PLNNs are particularly valuable for staging N1 stage DTC patients.
• The study identified an optimal cut-off of 13 PLNNs, enhancing prognostic model utility.