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Recursive partitioning analysis improves risk stratification in node-negative differentiated thyroid cancer: a
Xin Hua1, Hai-Ping You1, Yu-Ling Zhang2
1Department of Radiation Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Gland Surgery
|June 16, 2026
Summary
A new recursive partitioning analysis (RPA) staging system shows improved prognostic accuracy for node-negative differentiated thyroid cancer (DTC). This RPA model offers better prediction of overall survival compared to the current TNM staging system.
Area of Science:
- Oncology
- Epidemiology
- Biostatistics
Background:
- The Tumor-Node-Metastasis (TNM) staging system's applicability in node-negative differentiated thyroid cancer (DTC) is uncertain.
- Recursive partitioning analysis (RPA) is a potential alternative for staging refinement but its prognostic utility in node-negative DTC is unexplored.
Purpose of the Study:
- To develop and validate a novel RPA-based staging system for node-negative DTC.
- To compare the prognostic performance of the new RPA system with the AJCC TNM system.
Main Methods:
- Retrospective cohort study of 8,816 node-negative DTC patients from the SEER database.
- Patients were divided into training (n=6,172) and validation (n=2,644) sets.
- Cox proportional hazards models identified prognostic factors for RPA system development; performance assessed using Kaplan-Meier, tROC curves, and Harrell's C-index.
Main Results:
- The RPA model categorized patients into stages I-III with distinct 15-year overall survival (OS) rates (93.6%, 5.6%, 0%).
- The RPA system demonstrated significantly higher prognostic accuracy (C-index: 0.947 vs. 0.750) and AUC compared to the AJCC TNM system.
- Superior performance of the RPA model was confirmed in the validation set.
Conclusions:
- The developed and validated RPA-based model shows superior prognostic performance for node-negative DTC.
- This novel RPA staging system has the potential to enhance the clinical staging of lymph node-negative differentiated thyroid cancer.
