title: Prognostic nomograms to predict oncological outcome of thyroid cancers.
abstract: BACKGROUND
  Thyroid cancers represent a conglomerate of diverse histological types with equally variable prognosis. There is no reliable prognostic model to predict the risks of relapse and death for different types of thyroid cancers.
  
  
  OBJECTIVE
  The purpose of this study was to build prognostic nomograms to predict individualized risks of relapse and death of thyroid cancer within 10 years of diagnosis based on patients' prognostic factors.
  
  
  METHODS
  Competing risk subhazard models were used to develop prognostic nomograms based on the information on individual patients in a population-based thyroid cancer cohort followed up for a median period of 126 months. Analyses were conducted using R version 2.13.2. The R packages cmprsk10, Design, and QHScrnomo were used for modeling, developing, and validating the nomograms for prediction of patients' individualized risks of relapse and death of thyroid cancer.
  
  
  METHODS
  This study was performed at CancerCare Manitoba, the sole comprehensive cancer center for a population of 1.2 million.
  
  
  METHODS
  Participants were a population-based cohort of 2306 consecutive thyroid cancers observed in 2296 patients in the province of Manitoba, Canada, during 1970 to 2010.
  
  
  METHODS
  Outcomes were discrimination (concordance index) and calibration curves of nomograms.
  
  
  RESULTS
  Our cohort of 570 men and 1726 women included 2155 (93.4%) differentiated thyroid cancers. On multivariable analysis, patient's age, sex, tumor histology, T, N, and M stages, and clinically or radiologically detectable posttreatment gross residual disease were independent determinants of risk of relapse and/or death. The individualized 10-year risks of relapse and death of thyroid cancer in the nomogram were predicted by the total of the weighted scores of these determinants. The concordance indices for prediction of thyroid cancer-related deaths and relapses were 0.92 and 0.76, respectively. The calibration curves were very close to the diagonals.
  
  
  CONCLUSIONS
  We have successfully developed prognostic nomograms for thyroid cancer with excellent discrimination (concordance indices) and calibration.
authors.affiliation: MS, DNB, FRCS(Glasg.), FRCSEd, MNAMS, FRCSC,University of Manitoba, Head and Neck Surgical Oncologist, Cancer Care Manitoba, GF 440 A, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. alok.pathak@cancercare.mb.ca.
authors.forename: K Alok
authors.initials: KA
authors.lastname: Pathak
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazurat
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
authors.forename: Thomas
authors.initials: T
authors.lastname: Klonisch
authors.forename: Richard W
authors.initials: RW
authors.lastname: Nason
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy