Endocrinol Metab.  2020 Jun;35(2):435-442. 10.3803/EnM.2020.35.2.435.

Development and Validation of a Risk Scoring System Derived from Meta-Analyses of Papillary Thyroid Cancer

• Suh S
• Goh TS
• Kim YH
• Oh SO
• Pak K
• Seok JW
• Kim IJ

• KMID: 2503274
• DOI: http://doi.org/10.3803/EnM.2020.35.2.435

Abstract

Background
The aim of this study was to develop a scoring system to stratify the risk of papillary thyroid cancer (PTC) and to select the proper management.
Methods
We performed a systematic search of MEDLINE and Embase. Data regarding patients’ prognoses were obtained from the included studies. Odds ratios (ORs) with statistical significance were extracted from the publications. To generate a risk scoring system (RSS), ORs were summed (RSS1), and summed after natural-logarithmic transformation (RSS2). RSS1 and RSS2 were compared to the eighth edition of the American Joint Committee on Cancer (AJCC) staging system and the 2015 American Thyroid Association (ATA) guidelines for thyroid nodules and differentiated thyroid carcinoma.
Results
Five meta-analyses were eligible for inclusion in the study. Eight variables (sex, tumour size, extrathyroidal extension, BRAF mutation, TERT mutation, histologic subtype, lymph node metastasis, and distant metastasis) were included. RSS1 was the best of the analysed models.
Conclusion
We developed and validated a new RSS derived from previous meta-analyses for patients with PTC. This RSS seems to be superior to previously published systems.

Keyword

Thyroid cancer, papillary; Prognosis; Recurrence

Figure

• 

  Fig. 1 Flowchart of the meta-analysis selection process.

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  Fig. 2 Receiver operating characteristic curve analysis of RSS1 (area under the curve, 0.751), RSS2 (0.745), the eighth edition of the American Joint Committee on Cancer (AJCC, 0.659), and the 2015 American Thyroid Association (ATA) guideline (0.666). RSS, risk scoring system.

• 

  Fig. 3 Kaplan-Meier survival plots of (A) RSS1 (hazard ratio [HR], 4.241; 95% confidence interval [CI], 1.9541 to 9.6434; P<0.0001), (B) RSS2 (HR, 6.9736; 95% CI, 3.4553 to 14.0743; P=0.0002), (C) eighth edition of the American Joint Committee on Cancer (AJCC) (HR, 7.4592; 95% CI, 0.7834 to 71.0250; P<0.0001), and (D) the 2015 American Thyroid Association (ATA) guideline (intermediate risk: HR, 1.9005; 95% CI, 0.9115 to 3.9628) (high risk: HR, 9.2530; 95% CI, 1.5019 to 57.0051; P<0.0001). The cutoff values were 13.93 for RSS1 and 2.03 for RSS2. RSS, risk scoring system.

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