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

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Abstract

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with a rising incidence worldwide. Accurate prognostic models are essential for effective patient management. This study evaluates the prognostic value of various lymph node staging systems in DTC using a competing risks model. We used SEER database records (1998–2016) of 16,527 DTC patients, analyzing N stage, positive lymph node numbers (PLNNs), metastatic lymph node ratio (MLNR), log odds of positive lymph nodes (LODDS), and log odds of the negative lymph node (NLN)/T stage ratio (LONT). Univariate and multivariate analyses in a competing risks model were performed, along with subgroup analyses based on demographic and clinical characteristics. In this study of 16,527 patients with DTC, different lymph node staging systems showed different prognostic correlations in univariate and multivariate analyses. In particular, PLNNs showed significant prognostic correlations in several subgroups. Additionally, PLNNs were more suitable as a lymph node staging system for DTC than LODDS and MLNR in N1 stage subgroups, with an optimal cut-off of 13. Receiver operating characteristic curves, calibration curves and nomograms improved the clinical utility of the prognostic model based on PLNNs. Using competing risks model and subgroup analyses, we found that PLNNs had the best prognostic discriminatory efficacy for patients with DTC, especially those with N1 stage disease, and had an optimal cut-off value of 13.

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Availability of data and materials

All data used in SEER database is available online. Statistical code is available on the request by directly contacting the first author (email: 218202094@csu.edu.cn).

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Funding

The research is supported by Natural Science Foundation of Hunan Province (2023JJ60086), Hunan Provincial Health Commission Key Guidance Project (C202314027163 2022) and Xiangya Second Hospital Clinical Nursing Research Key Fund (2022-HLKY-02).

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Authors and Affiliations

  1. Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha City, Hunan Province, China

    Zhe Xu Cao, Jiang Sheng Huang & Ming Ming Wang

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  1. Zhe Xu Cao
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  2. Jiang Sheng Huang
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  3. Ming Ming Wang
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Contributions

All authors listed had made a substantial contribution to the work. ZXC: conceptualization, methodology, visualization, writing original draft, writing review and editing. JSH: conceptualization, formal analysis, writing review and editing, supervision. MMW: data curation, funding acquisition, project administration, project administration, writing review and editing.

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Correspondence to Ming Ming Wang.

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All data was obtained from public databases and The SXH Research Ethics Committee has confirmed that no ethical approval is required.

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Cao, Z.X., Huang, J.S. & Wang, M.M. Application and subgroup analysis of competing risks model based on different lymph node staging systems in differentiated thyroid cancer. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01851-1

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