Abstract
Purpose
To investigate the risk factors of second primary malignant tumor (SPMT) in patients with differentiated thyroid cancer (DTC) and establish a competing risk nomogram to predict the probability of SPMT occurrence.
Methods
We retrieved data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with DTC between 2000 and 2019. The Fine and Gray subdistribution hazard model was employed to identify SPMT risk factors in the training set and develop a competing risk nomogram. Model evaluation was performed using area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).
Results
A total of 112,257 eligible patients were included in the study and randomized into a training set (n = 112,256) and a validation set (n = 33,678). The cumulative incidence rate of SPMT was 15% (n = 9528). Age, sex, race, tumor multifocality, and TNM stage were independent risk factors of SPMT. The calibration plots showed good agreement between the predicted and observed SPMT risks. The 10-year AUCs of the calibration plots were 70.2 (68.7–71.6) in the training set and 70.2 (68.7–71.5) in the validation set. Moreover, DCA showed that our proposed model resulted in higher net benefits within a defined range of risk thresholds. The cumulative incidence rate of SPMT differed among risk groups, classified according to nomogram risk scores.
Conclusion
The competing risk nomogram developed in this study exhibits high performance in predicting the occurrence of SPMT in patients with DTC. These findings may help clinicians identify patients at distinct levels of risk of SPMT and develop corresponding clinical management strategies.
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Data availability
SEER Stat 8.4.1 software was used to extract our data online, and data in our study is available at SEER database: https://seer.cancer.gov/. In addition, the raw data for this study are available in the supplementary material.
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The authors declare that no funds, Grants, or other support were received during the preparation of this manuscript. This work was supported by National Natural Science Foundation, Regional Science Foundation Project (Grant numbers: 81960322 and 82160343), Joint Program of Applied Basic Research of Yunnan Provincial Department of Science and Technology—Kunming Medical University (Grant number: NO. 202301AY070001-106), and "Famous Doctor" Special Project of Ten Thousand People Plan of Yunnan Province (Grant number: YNWR-MY-2020-095).
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All authors contributed to the study conception and design. Data preparation and collection were performed by FH, TC, CL, XDS and JL. Data analysis was carried out by FH, CLY and ZXY. Manuscript writing was performed by FH. Study supervision and revision of the manuscript were performed by ZYD and CL. And all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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As the data from the SEER database are publicly available, our study was exempt from ethical committee approval. Furthermore, we declare that all methods were performed in accordance with relevant guidelines and regulations.
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Supplementary file2Fig. S2 Time-dependent ROC curves of the competing risk nomogram for predicting 3-, 5-, and 10-year SPMT’s probabilities in the training set (a) and validation set (b) (PDF 280 KB)
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Hou, F., Cheng, T., Yang, CL. et al. Risk prediction of second primary malignant tumor in primary differentiated thyroid cancer patients: a population-based study. J Cancer Res Clin Oncol 149, 12379–12391 (2023). https://doi.org/10.1007/s00432-023-05135-w
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DOI: https://doi.org/10.1007/s00432-023-05135-w