Nomogram incorporating preoperative clinical and ultrasound indicators to predict aggressiveness of solitary papillary thyroid carcinoma

OBJECTIVE: To construct a nomogram based on preoperative clinical and ultrasound indicators to predict aggressiveness of solitary papillary thyroid carcinoma (PTC). METHODS: Preoperative clinical and ultrasound data from 709 patients diagnosed with solitary PTC between January 2017 and December 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with PTC aggressiveness, and these factors were used to construct a predictive nomogram. The nomogram’s performance was evaluated in the primary and validation cohorts. RESULTS: The 709 patients were separated into a primary cohort (n = 424) and a validation cohort (n = 285). Univariate analysis in the primary cohort showed 13 variables to be associated with aggressive PTC. In multivariate logistic regression analysis, the independent predictors of aggressive behavior were age (OR, 2.08; 95% CI, 1.30-3.35), tumor size (OR, 4.0; 95% CI, 2.17-7.37), capsule abutment (OR, 2.53; 95% CI, 1.50-4.26), and suspected cervical lymph nodes metastasis (OR, 2.50; 95% CI, 1.20-5.21). The nomogram incorporating these four predictors showed good discrimination and calibration in both the primary cohort (area under the curve, 0.77; 95% CI, 0.72-0.81; Hosmer–Lemeshow test, P = 0.967 and the validation cohort (area under the curve, 0.72; 95% CI, 0.66-0.78; Hosmer–Lemeshow test, P = 0.251). CONCLUSION: The proposed nomogram shows good ability to predict PTC aggressiveness and could be useful during treatment decision making. ADVANCES IN KNOWLEDGE: Our nomogram—based on four indicators—provides comprehensive assessment of aggressive behavior of PTC and could be a useful tool in the clinic.