Combined prognostic value of preoperative serum thyrotrophin and thyroid hormone concentration in papillary thyroid cancer

Background A growing number of studies have found a close association between thyroid hormones and thyrotrophin (TSH), and they also have prognostic significance in some cancer types; this study aimed to investigate the prognostic value of free triiodothyronine (fT3), free thyroxine (fT4), fT3/fT4, TSH, and their combination in patients with papillary thyroid carcinoma (PTC). Methods This study retrospectively analyzed the relevant data of 726 newly diagnosed PTC patients. Both univariate and multivariate analyses were used to predict the recurrence rate, and a risk score was established. In addition, with the use of a random survival forest, a random forest (RF) score was constructed. After calculating the area under the curve (AUC), the diagnostic efficacy of risk score, RF score, and four indicators was compared. Results fT3, fT4, fT3/fT4, and TSH were strongly associated with some invasive clinicopathological features and postoperative recurrence. Patients with high expression of fT4 and TSH have a high risk of recurrence. By contrast, patients with high expression of fT3 and fT3/fT4 have a low risk of recurrence. At the same time, the combined use of various indicators is more helpful for establishing an accurate diagnosis. By comparison, we found that the RF score was better than the risk score in terms of predicting the recurrence of PTC. Conclusion The diagnostic accuracy of a combination of fT3, fT4, fT3/fT4, and TSH can help improve our clinical estimate of the risk of recurrent PTC, thus allowing the development of a more effective treatment plan for patients. In this study, we investigated the association of TSH,fT3,fT4,and fT3 / fT4 with recurrence in PTC patients. We are the first to use machine learning method to comprehensively analyze TSH,fT3,fT4 and fT3 / fT4,and to explore the ability of their combined indicators in judging the recurrence of PTC patients. We found that combining the four indicators significantly improved the ability to predict recurrence in patients. Therefore, the internal association among these them and how to affect the recurrence are worth further exploration.