Renee E. Park


May 2009

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: The application of appropriate treatment for differentiated thyroid cancer (DTC), including extent of surgery and adjuvant therapy, is predicated on accurate patient risk stratification. Although risk factors for mortality from DTC have been well-described on the population level, they have not been unified into a single algorithm to predict individual risk. This study aimed to develop a nomogram for estimating 10-year cause specific mortality in well to poorly DTC. Methods: A historical cohort of 9,654 patients with DTC recorded in the SEER national cancer registry from 1985 to 1995 was used to identify and quantify all clinically relevant predictors of 10-year cancer-specific mortality. Multivariable Cox proportional hazards regression was used for model selection and nomogram development. The predictive accuracy of the nomogram was internally validated using bootstrapping methods and quantitated using the area under the receiver operating characteristic curve (AUC). Results: Ten-year cause-specific mortality was 3.3%. Significant predictors of mortality included age, gender, extracapsular extension, tumor size, nodal status, distant metastasis and histology. The nomogram successfully estimated an individualized risk of mortality from DTC by assigning relative weights to each of these risk factors. Model discrimination was excellent with an AUC of 0.93, with good calibration. Discussion & Conclusions: This nomogram is the first prognostic model developed to predict the likelihood of mortality for an individual patient with DTC. More accurate patient risk stratification using the nomogram has practical applications for clinical care and research.




School of Medicine



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