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Thyroglobulin measurement is the most powerful outcome predictor in differentiated thyroid cancer: a decision tree analysis in a European multicenter series

  • Luca Giovanella EMAIL logo , Lisa Milan , Wolfgang Roll , Manuel Weber , Simone Schenke , Michael Kreissl , Alexis Vrachimis , Kim Pabst , Tuncel Murat , Petra Petranović Ovčariček , Alfredo Campenni , Rainer Görges and Luca Ceriani
Published/Copyright: May 7, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 62 Issue 11

Abstract

Objectives

An accurate prognostic assessment is pivotal to adequately inform and individualize follow-up and management of patients with differentiated thyroid cancer (DTC). We aimed to develop a predictive model for recurrent disease in DTC patients treated by surgery and 131I by adopting a decision tree model.

Methods

Age, sex, histology, T stage, N stage, risk classes, remnant estimation, thyroid-stimulating hormone (TSH), thyroglobulin (Tg), administered 131I activities and post-therapy whole body scintigraphy (PT-WBS) were identified as potential predictors and put into regression algorithm (conditional inference tree, c-tree) to develop a risk stratification model for predicting persistent/recurrent disease over time.

Results

The PT-WBS pattern identified a partition of the population into two subgroups (PT-WBS positive or negative for distant metastases). Patients with distant metastases exhibited lower disease-free survival (either structural, DFS-SD, and biochemical, DFS-BD, disease) compared to those without metastases. Meanwhile, the latter were further stratified into three risk subgroups based on their Tg values. Notably, Tg values >63.1 ng/mL predicted a shorter survival time, with increased DFS-SD for Tg values <63.1 and <8.9 ng/mL, respectively. A comparable model was generated for biochemical disease (BD), albeit different DFS were predicted by slightly different Tg cutoff values (41.2 and 8.8 ng/mL) compared to DFS-SD.

Conclusions

We developed a simple, accurate and reproducible decision tree model able to provide reliable information on the probability of structurally and/or biochemically persistent/relapsed DTC after a TTA. In turn, the provided information is highly relevant to refine the initial risk stratification, identify patients at higher risk of reduced structural and biochemical DFS, and modulate additional therapies and the relative follow-up.

Keywords: differentiated thyroid carcinoma; disease free survival; thyroglobulin; decision tree model
Corresponding author: Luca Giovanella, MD, PhD, Nuclear Medicine, Gruppo Ospedaliero Moncucco, Lugano, Switzerland; and Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland, Phone: 0041 (0)91 960 81 11, E-mail:

  1. Research ethics: The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This is an observational retrospective study. The Chamber of Physicians of Westfalen-Lippe, Germany, has confirmed that no ethical approval is required and informed consent was waived.

  2. Informed consent: This is an observational retrospective study. The Chamber of Physicians of Westfalen-Lippe, Germany, has confirmed that no ethical approval is required and informed consent was waived.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Ente Ospedaliero Cantonale, Bellinzona, Switzerland.

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Received: 2024-03-30
Accepted: 2024-04-23
Published Online: 2024-05-07
Published in Print: 2024-10-28

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2024-0405
Keywords for this article
differentiated thyroid carcinoma; disease free survival; thyroglobulin; decision tree model

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Circulating tumor DNA measurement: a new pillar of medical oncology?
  4. Reviews
  5. Circulating tumor DNA: current implementation issues and future challenges for clinical utility
  6. Circulating tumor DNA methylation: a promising clinical tool for cancer diagnosis and management
  7. Opinion Papers
  8. The final part of the CRESS trilogy – how to evaluate the quality of stability studies
  9. The impact of physiological variations on personalized reference intervals and decision limits: an in-depth analysis
  10. Computational pathology: an evolving concept
  11. Perspectives
  12. Dynamic mirroring: unveiling the role of digital twins, artificial intelligence and synthetic data for personalized medicine in laboratory medicine
  13. General Clinical Chemistry and Laboratory Medicine
  14. Macroprolactin in mothers and their babies: what is its origin?
  15. The influence of undetected hemolysis on POCT potassium results in the emergency department
  16. Quality control in the Netherlands; todays practices and starting points for guidance and future research
  17. QC Constellation: a cutting-edge solution for risk and patient-based quality control in clinical laboratories
  18. OILVEQ: an Italian external quality control scheme for cannabinoids analysis in galenic preparations of cannabis oil
  19. Using Bland-Altman plot-based harmonization algorithm to optimize the harmonization for immunoassays
  20. Comparison of a two-step Tempus600 hub solution single-tube vs. container-based, one-step pneumatic transport system
  21. Evaluating the HYDRASHIFT 2/4 Daratumumab assay: a powerful approach to assess treatment response in multiple myeloma
  22. Insight into the status of plasma renin and aldosterone measurement: findings from 526 clinical laboratories in China
  23. Reference Values and Biological Variations
  24. Reference values for plasma and urine trace elements in a Swiss population-based cohort
  25. Stimulating thyrotropin receptor antibodies in early pregnancy
  26. Within- and between-subject biological variation estimates for the enumeration of lymphocyte deep immunophenotyping and monocyte subsets
  27. Diurnal and day-to-day biological variation of salivary cortisol and cortisone
  28. Web-accessible critical limits and critical values for urgent clinician notification
  29. Cancer Diagnostics
  30. Thyroglobulin measurement is the most powerful outcome predictor in differentiated thyroid cancer: a decision tree analysis in a European multicenter series
  31. Cardiovascular Diseases
  32. Interaction of heparin with human cardiac troponin complex and its influence on the immunodetection of troponins in human blood samples
  33. Diagnostic performance of a point of care high-sensitivity cardiac troponin I assay and single measurement evaluation to rule out and rule in acute coronary syndrome
  34. Corrigendum
  35. Reference intervals of 24 trace elements in blood, plasma and erythrocytes for the Slovenian adult population
  36. Letters to the Editor
  37. Disturbances of calcium, magnesium, and phosphate homeostasis: incidence, probable causes, and outcome
  38. Validation of the enhanced liver fibrosis (ELF)-test in heparinized and EDTA plasma for use in reflex testing algorithms for metabolic dysfunction-associated steatotic liver disease (MASLD)
  39. Detection of urinary foam cells diagnosing the XGP with thrombopenia preoperatively: a case report
  40. Methemoglobinemia after sodium nitrite poisoning: what blood gas analysis tells us (and what it might not)
  41. Novel thiopurine S-methyltransferase (TPMT) variant identified in Malay individuals
  42. Congress Abstracts
  43. 56th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC – Laboratory Medicine)
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