This article is more than 5 years old. Information may no longer be current.
Nomogram predicts prognosis, guides follow-up plans in patients with medullary thyroid cancer
Click Here to Manage Email Alerts
CORONADO, Calif. — A predictive nomogram can help assist in counseling of patients with medullary thyroid cancer in terms of prognosis as well as with subsequent clinical follow up, according to findings presented here.
“Medullary thyroid cancer is a very rare form of thyroid cancer,” Ian Ganly, MD, PhD, of the department of head and neck surgery at Memorial Sloan-Kettering Cancer Center in New York, told Endocrine Today. “There are only 1,200 cases diagnosed in the United States each year. Unlike differentiated thyroid cancer, these patients have a relatively poorer outcome with an overall survival of 65% over 10 years.”
Ian Ganly
Ganly and colleagues evaluated 249 patients with medullary thyroid cancer to create a predictive nomogram for cancer-specific mortality.
“The normal way for estimating survival in such patients is the TNM staging system, but this staging system has some faults associated with it,” Ganly said. “The TNM system is very good for estimating survival in a population of patients, but it’s not very good for estimating survival in individual patients.”
According to Ganly, there are many important variables when predicting outcomes in patients with medullary thyroid cancer including age, gender, RET mutation, calcitonin levels, vascular invasion, grade of differentiation and others. The current TNM system does not incorporate any of these prognostic factors to predict outcome.
The nomogram used seven factors that were considered highly accurate to predict outcome including age, gender, postoperative calcitonin levels, TNM status, and presence of perivascular invasion.
“This nomogram gives a very accurate estimate of cancer specific mortality at 10 years for individual patients,” Ganly said. “[This] shows us superiority to the TNM system, which only applies to populations of patients.”
Overall, 22.5% of patients died from medullary thyroid cancer, whereas 6.4% died as a result of other causes.
According to Ganly, the nomogram has a very good concordance index of 0.77, meaning the predictive mortality for individual patients was very close to the observed mortality.
“We do believe the nomogram is very useful and will be very good for giving an accurate assessment of outcome to individual patients so it’s good for counseling such patients,” Ganly said. “It is also good for determining the intensity of consultation and imaging in the follow-up period.” — by Amber Cox
For more information:
Ho AS. Oral #16. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.