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. 2021 Aug;10(16):5488-5498.
doi: 10.1002/cam4.4112. Epub 2021 Jul 9.

Development and validation of a nomogram based on stromal score to predict progression-free survival of patients with papillary thyroid carcinoma

Jiajia Tang  1 , Shitao Jiang  2 , Qiong Gao  1 , Xuehua Xi  3 , Luying Gao  1 , Ruina Zhao  1 , Xingjian Lai  1 , Bo Zhang  3 , Yuxin Jiang  1
Affiliations

Development and validation of a nomogram based on stromal score to predict progression-free survival of patients with papillary thyroid carcinoma

Jiajia Tang et al. Cancer Med. 2021 Aug.

Abstract

Background: Growing evidence has proved that stromal cells, as the critical component of tumor microenvironment (TME), are closely associated with tumor's progression. However, the model based on stromal score to predict progression-free survival (PFS) in papillary thyroid carcinoma (PTC) has not been developed. The study aimed at exploring the relation between stromal score and prognosis, then establishing a nomogram to predict PFS of patients with PTC.

Method: We obtained the stromal score and clinicopathological characteristics of PTC patients from The Cancer Genome Atlas (TCGA) database. Cox regression analysis assisted in selecting prognosis-related factors. A stromal score-based nomogram was built and verified in the training and validation cohorts, respectively. The calibration curve, concordance index (C-index), decision curve analysis (DCA) as well as receiver operating characteristic (ROC) curve assisted in measuring the performance exhibited by the nomogram.

Results: We divided 381 PTC patients into the training cohort (n = 269) and the validation cohort (n = 112) randomly. Compared with patients who had a low stromal score, patients with a high stromal score appeared with significantly better PFS [Hazard ratio (HR) and 95% confidence interval (CI): 0.294, 0.130-0.664]. The C-index of the PFS nomogram was 0.764 (0.662-0.866) in the training cohort and 0.717 (0.603-0.831) in the validation cohort. The calibration curves for PFS prediction in the nomogram were remarkably consistent with the actual observation. DCA indicated superior performance of the nomogram to predict PFS than the American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) staging system. The ROC curves showed the favorable sensitivity and specificity of the novel nomogram.

Conclusion: High stromal score was significantly associated with improved PFS in patients with PTC. The nomogram based on the stromal score and clinicopathological patterns yielded a reliable performance to predict the prognosis of PTC.

Keywords: nomogram; papillary thyroid carcinoma; progression-free survival; stromal score.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
The flowchart detailing the successive steps of data processing. AJCC TNM, American Joint Committee on Cancer Tumor Node Metastasis; T, tumor
FIGURE 2
FIGURE 2
Identification of optimal cutoff points of diagnostic age and stromal score by X‐tile software analyses. (A, B) Optimal cutoff value of the diagnostic age was identified as 57 years based on progression‐free survival. (C, D) Optimal cutoff value of the stromal score was identified as −677.0 based on progression‐free survival
FIGURE 3
FIGURE 3
The correlations of stromal score with clinicopathological characteristics and progression‐free survival (PFS) of papillary thyroid carcinoma. (A) Correlation of the stromal score with T status. (B) Association of the stromal score with N status. (C) Comparison of PFS in patients with high and low stromal score groups. T, tumor; N, Node; NX, cancer in nearby lymph nodes cannot be measured
FIGURE 4
FIGURE 4
A prognostic nomogram predicting 1‐, 2‐, 3‐, 4‐, and 5‐year progression‐free survival (PFS) of papillary thyroid carcinoma. For using the nomogram, values of each variable from an individual patient are located on each variable axis, and a line is drawn upward to determine the points obtained for each variable on the point axis. The sum of these numbers is located on the total points axis, and a line is drawn downward to the survival axis to determine the likelihood of 1‐, 2‐, 3‐, 4‐, and 5‐year PFS. T, Tumor; M, Metastasis; MX, Metastasis cannot be measured
FIGURE 5
FIGURE 5
Calibration plots of progression‐free survival (PFS) associated nomogram in both training and validation cohorts. (A, B, C) Calibration plots of 1‐, 2‐, and 3‐year PFS in the training cohort. (D, E, F) Calibration plots of 1‐, 2‐, and 3‐year PFS in the validation cohort
FIGURE 6
FIGURE 6
Decision curve analysis (DCA) of the nomogram for progression‐free survival (PFS) in both training and validation cohorts. (A‐C) The DCA of nomogram for predicting 1‐, 2‐, and 3‐year PFS in the training cohort. (D) The DCA of nomogram for predicting 3‐year PFS in the validation cohort. AJCC TNM, American Joint Committee on Cancer Tumor Node Metastasis
FIGURE 7
FIGURE 7
Receiver operating characteristic (ROC) curves for the nomogram. (A) The ROC curves of nomogram with 1‐, 2‐, and 3‐year progression‐free survival in the training cohort. (B) The ROC curves of nomogram with 1‐, 2‐, and 3‐year progression‐free survival in the validation cohort. AUC, area under ROC curve
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