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. 2020 Aug;9(4):907-918.
doi: 10.21037/gs-20-273.

Synergic effects of histology subtype, lymph node metastasis, and distant metastasis on prognosis in differentiated thyroid carcinoma using the SEER database

Ling Zhou  1 , Qianqian Li  1 , Sichao Chen  1 , Yihui Huang  1 , Wei Wei  2 , Chao Zhang  3 , Min Wang  1 , Wei Zhou  1 , Wen Zeng  4 , Zeming Liu  1 , Liang Guo  1
Affiliations

Synergic effects of histology subtype, lymph node metastasis, and distant metastasis on prognosis in differentiated thyroid carcinoma using the SEER database

Ling Zhou et al. Gland Surg. 2020 Aug.

Abstract

Background: Differentiated thyroid carcinoma (DTC) is the most common clinical type of thyroid carcinoma. There are rare reports on the synergic effects of the different clinicopathological risk factors on the prognosis of it.

Methods: We retrospectively reviewed data on 86,032 DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were conducted to evaluate the correlation between clinicopathological factors and the prognosis of DTC. Relative excess risk (RERI) of synergic effect, attributable proportion (AP) of synergic effect, and synergy index (SI) were calculated to assess synergic effects. Kaplan-Meier analyses with log-rank tests was used to plot the survival curve affected by different risk factors.

Results: Histology subtype, lymph node metastasis (LNM) status, and distant metastasis (DM) were independent risk factors for cancer-specific survival (CSS) and all-cause survival (ACS) in the multivariate analysis (all, P<0.001). Patients' age at diagnosis, sex, extrathyroidal extension, and radiation also influenced prognosis (all, P<0.001). The cancer-specific mortality (CSM) and all-cause mortality (ACM) rates per 1,000 person-years were higher in patients with follicular thyroid carcinoma (FTC) and in those with N1 stage and M1 stage disease. Furthermore, we observed a significant synergic effect between histology subtype and N stage, as well as histology subtype and M stage for the CSM of DTC (RERI =48.806, AP =0.853, SI =7.565; RERI =37.889, AP =0.430, SI =1.771, respectively). However, no synergic effect was observed in the case of the N stage and M stage for the CSM of DTC (RERI =7.928, AP =0.084, SI =1.093).

Conclusions: Patients with histology subtype of FTC and N1 stage, histology subtype of FTC and M1 stage had significant additive synergic effects on DTC prognosis for CSM.

Keywords: Differentiated thyroid carcinoma (DTC); Surveillance, Epidemiology, and End Results (SEER); prognosis; synergic effect.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-273). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of data selection.
Figure 2
Figure 2
Survival in lymph lode metastasis and DTC patients. (A) Effects of histology subtype and N stage on CSS of patients with DTC; (B) effects of histology subtype and N stage on ACS of patients with DTC. CSS, cancer-specific survival; DTC, differentiated thyroid cancer; ACS, all-cause survival; PTC, papillary thyroid cancer; FTC, follicular thyroid cancer.
Figure 3
Figure 3
Survival in distant metastasis and DTC patients. (A) Effects of histology subtype and M stage on CSS of patients with DTC; (B) effects of histology subtype and M stage on ACS of patients with DTC. DTC, differentiated thyroid cancer; CSS, cancer-specific survival; ACS, all-cause survival.
Figure 4
Figure 4
Survival in lymph lode metastasis and distant metastasis with DTC patients. (A) Effects of N stage and M stage on CSS of patients with DTC; (B) effects of N stage and M stage on ACS of patients with DTC. DTC, differentiated thyroid cancer; CSS, cancer-specific survival; ACS, all-cause survival.
See this image and copyright information in PMC

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