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Optimal Cutoff Age for Predicting Mortality Associated with Differentiated Thyroid Cancer.

Kim SJ, Myong JP, Suh H, Lee KE, Youn YK - PLoS ONE (2015)

Bottom Line: With a median follow-up of 5.4 years (range, 0-22.9 years), DTC-associated mortality was 1.5% (n = 533) and the rate of death from overall cause was 7.0% (n = 2482).Multivariate analysis found that the age-at-diagnosis is the most prognostic factor for thyroid-cancer-specific death (HR 10.02, 95% CI 8.18-12.28).This finding might be used as consideration in revision of the risk stratification system for treatment of DTC patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Hospital & College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea.

ABSTRACT
Patient's age at the time of diagnosis is an important prognostic factor for differentiated thyroid cancer (DTC) as reflected in various staging and risk stratification systems. However, discrepancies exist among the different staging systems on an optimal cut-off age for predicting the clinical outcome of patients with DTC. To determine the age at diagnosis most predictive of clinical outcomes of DTC, a population-based cohort study was performed composed of 35,323 patients with DTC between 1988 and 2010 using the Surveillance, Epidemiology, and End Results (SEER) database. The Youden index J was used to determine the most predictive age-at-diagnosis for thyroid-cancer-specific death. The multivariate Cox proportional hazards model was used to determine the hazard ratios (HRs) for each age group. With a median follow-up of 5.4 years (range, 0-22.9 years), DTC-associated mortality was 1.5% (n = 533) and the rate of death from overall cause was 7.0% (n = 2482). The optimal cutoff age at diagnosis for thyroid-cancer-specific death was 57. Multivariate analysis found that the age-at-diagnosis is the most prognostic factor for thyroid-cancer-specific death (HR 10.02, 95% CI 8.18-12.28). Age at diagnosis is the most important prognostic factor for DTC patients. Based on our analysis, age at diagnosis of 57 might be the optimal predictor of thyroid-cancer-specific death. This finding might be used as consideration in revision of the risk stratification system for treatment of DTC patients.

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Related in: MedlinePlus

Multivariate Cox proportional hazard ratios for all cause of death, and cancer specific death with 95% confidence intervals, and Youden Index J derived from an univariate analysis at every age.
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pone.0130848.g002: Multivariate Cox proportional hazard ratios for all cause of death, and cancer specific death with 95% confidence intervals, and Youden Index J derived from an univariate analysis at every age.

Mentions: For descriptive statistics, the Student t test was employed for continuous variables while the chi-square test was employed for categorical variables. The Youden index J was used to determine the optimal cutoff age at the times of diagnosis for predicting overall and cancer-specific cause of death. The Youden index J was defined as: J = sensitivity + specificity-1 [14]. Youden index J in Fig 2 was derived from an univariate analysis. For the univariate assessments with dichotomous age as the predictive variable, survival curves for overall survival and cancer-specific survival were estimated using the Kaplan-Meier method and analyzed using the log-rank test. The dichotomous age points were chosen based on the Youden J index results in Fig 2.


Optimal Cutoff Age for Predicting Mortality Associated with Differentiated Thyroid Cancer.

Kim SJ, Myong JP, Suh H, Lee KE, Youn YK - PLoS ONE (2015)

Multivariate Cox proportional hazard ratios for all cause of death, and cancer specific death with 95% confidence intervals, and Youden Index J derived from an univariate analysis at every age.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477980&req=5

pone.0130848.g002: Multivariate Cox proportional hazard ratios for all cause of death, and cancer specific death with 95% confidence intervals, and Youden Index J derived from an univariate analysis at every age.
Mentions: For descriptive statistics, the Student t test was employed for continuous variables while the chi-square test was employed for categorical variables. The Youden index J was used to determine the optimal cutoff age at the times of diagnosis for predicting overall and cancer-specific cause of death. The Youden index J was defined as: J = sensitivity + specificity-1 [14]. Youden index J in Fig 2 was derived from an univariate analysis. For the univariate assessments with dichotomous age as the predictive variable, survival curves for overall survival and cancer-specific survival were estimated using the Kaplan-Meier method and analyzed using the log-rank test. The dichotomous age points were chosen based on the Youden J index results in Fig 2.

Bottom Line: With a median follow-up of 5.4 years (range, 0-22.9 years), DTC-associated mortality was 1.5% (n = 533) and the rate of death from overall cause was 7.0% (n = 2482).Multivariate analysis found that the age-at-diagnosis is the most prognostic factor for thyroid-cancer-specific death (HR 10.02, 95% CI 8.18-12.28).This finding might be used as consideration in revision of the risk stratification system for treatment of DTC patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Hospital & College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea.

ABSTRACT
Patient's age at the time of diagnosis is an important prognostic factor for differentiated thyroid cancer (DTC) as reflected in various staging and risk stratification systems. However, discrepancies exist among the different staging systems on an optimal cut-off age for predicting the clinical outcome of patients with DTC. To determine the age at diagnosis most predictive of clinical outcomes of DTC, a population-based cohort study was performed composed of 35,323 patients with DTC between 1988 and 2010 using the Surveillance, Epidemiology, and End Results (SEER) database. The Youden index J was used to determine the most predictive age-at-diagnosis for thyroid-cancer-specific death. The multivariate Cox proportional hazards model was used to determine the hazard ratios (HRs) for each age group. With a median follow-up of 5.4 years (range, 0-22.9 years), DTC-associated mortality was 1.5% (n = 533) and the rate of death from overall cause was 7.0% (n = 2482). The optimal cutoff age at diagnosis for thyroid-cancer-specific death was 57. Multivariate analysis found that the age-at-diagnosis is the most prognostic factor for thyroid-cancer-specific death (HR 10.02, 95% CI 8.18-12.28). Age at diagnosis is the most important prognostic factor for DTC patients. Based on our analysis, age at diagnosis of 57 might be the optimal predictor of thyroid-cancer-specific death. This finding might be used as consideration in revision of the risk stratification system for treatment of DTC patients.

No MeSH data available.


Related in: MedlinePlus