Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2025; 15(5): 103628
Published online May 19, 2025. doi: 10.5498/wjp.v15.i5.103628
Predictors of poor prognosis in long-term survivors of differentiated thyroid cancer with psychiatric disorders
Jin-Liang Jia, Ji-Hua Han, Rui Pang, Wen Bi, Bo Liu, Kun Yang
Jin-Liang Jia, Ji-Hua Han, Rui Pang, Wen Bi, Bo Liu, Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Kun Yang, Department of Anesthesiology, Harbin Medical University Affiliated Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Author contributions: Jia JL conceptualized and designed the research study, analyzed the data, and contributed to the writing of the manuscript; Han JH conducted the research, collected and managed the data, and participated in the analysis; Pang R contributed to the development of analytical tools and reagents, and assisted in data interpretation; Bi W provided new reagents and analytical tools, and co-wrote the manuscript; Liu B assisted in data collection and analysis, and contributed to the interpretation of results; Yang K supervised the study, provided critical feedback, and contributed to the final editing of the manuscript; all authors reviewed and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Harbin Medical University Cancer Hospital Institutional Review Board.
Informed consent statement: All subjects understood and agreed to the study protocol and voluntarily provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun Yang, Associate Chief Physician, Department of Anesthesiology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin 150081, Heilongjiang Province, China. 13804556449@163.com
Received: February 12, 2025
Revised: March 14, 2025
Accepted: April 8, 2025
Published online: May 19, 2025
Processing time: 77 Days and 0.3 Hours
Abstract
BACKGROUND

Thyroid malignancies, while accounting for a small proportion of cancer diagnoses globally, have demonstrated a consistent upward trend in occurrence across diverse populations, with gender-specific analyses revealing a disproportionate burden among women. Despite the characteristically indolent nature of most thyroid carcinomas and their associated high survival rates, emerging evidence points to significant unmet needs regarding psychosocial adaptation and neuropsychiatric sequelae in this growing survivor population. The spectrum of mental health conditions, ranging from affective and anxiety disorders to cognitive impairments, presents substantial barriers to functional recovery and may potentially influence disease trajectories through complex psychoneuroimmunological pathways. Clinical observations consistently report elevated rates of mood disturbances and executive function deficits persisting throughout the cancer continuum, from active treatment into extended follow-up periods. These findings highlight a critical knowledge gap in understanding the dynamic interplay between thyroid cancer biology, its therapeutic interventions, and the development of treatment-resistant psychiatric manifestations that complicate long-term patient care.

AIM

To analyse the factors influencing the poor prognosis of patients surviving long-term differentiated thyroid cancer with psychiatric disorders and to construct a prediction model.

METHODS

Forty-eight patients with mental disorders combined with differentiated thyroid cancer who were treated in our hospital during the period of March 2018 to March 2023 were retrospectively selected as the study subjects (thyroid cancer group), and 30 cases each of patients with mental disorders combined with benign thyroid nodules (benign nodules group) and patients with mental disorders alone (mental disorders group), who were treated during the same time period, were selected as controls. The patients with differentiated thyroid cancer were further divided into a poor prognosis group (10 cases) and a good prognosis group (38 cases). The study outcome was poor prognosis as shown by whole body bone imaging within 2 years after thyroid cancer surgery. Factors influencing poor prognosis in survivors of differentiated thyroid cancer were analyzed by univariate and multivariate logistic regression analyses, receiver operating characteristic (ROC) curve analysis was used to assess the predictive efficacy of these factors for poor prognosis, and the DeLong test was used to determine whether there was a statistically significant difference in the area under the curve (AUC) of the model.

RESULTS

One-way logistic regression analysis showed that tumour diameter [odds ratio (OR) = 19.190, P = 0.002], T-stage (OR = 7.692, P = 0.018), extra-glandular infiltration (OR = 37.000, P = 0.003), degree of differentiation (OR = 24.667, P = 0.008), serum free T3 (OR = 22.348, P = 0.025), serum free T4 (FT4) (OR = 1.158, P = 0.002), total bilirubin (TBil) (OR = 1.792, P = 0.004), albumin (OR = 0.675, P = 0.003), cortisol (OR = 1.180, P = 0.003), norepinephrine (OR = 1.047, P = 0.002), angiotensin II (OR = 1.975, P = 0.002), and superoxide dismutase (OR = 0.515, P = 0.005) all increased the risk of poor prognosis in patients with psychiatric disorders and long-term differentiated thyroid cancer. Multifactorial logistic regression analysis showed that tumour diameter (OR = 16.570, P = 0.021), extra-glandular infiltration (OR = 53.145, P = 0.010), FT4 (OR = 1.186, P = 0.007), and TBil (OR = 2.823, P = 0.048) were independent risk factors for poor prognosis of patients with psychiatric disorders with long-term differentiated thyroid cancer, and the regression equation was: Y = 2.808 × tumour diameter + 3.973 × extra-glandular infiltration + 0.171 × FT4 + 1.038 × TBil - 88.138. ROC analysis showed that the predictive power of the overall model (AUC = 0.992, P = 0.000) was significantly higher than that of independent risk factors (DeLong test P < 0.05).

CONCLUSION

Tumour diameter, extra-glandular infiltration, FT4, and TBil are independent risk factors for poor prognosis in patients with psychiatric disorders with long-term differentiated thyroid cancer, and the combination of these factors is of higher value in predicting the prognosis of patients. These risk factors can be used as a basis to develop a reasonable prognostic management plan in clinical practice for patients with long-term differentiated thyroid cancer with mental disorders, so as to improve the prognosis and quality of life of patients.

Keywords: Mental disorders; Differentiated thyroid cancer; Poor prognosis; Influencing factors; Prediction

Core Tip: The innovative and significant finding of this study is that the combination of tumour diameter, extra-glandular infiltration, serum free T4 levels, and total bilirubin serves as an independent risk factor for poor prognosis in patients with psychiatric disorders and long-term differentiated thyroid cancer, providing higher predictive value for patient prognosis and serving as a basis for developing a reasonable prognostic management plan in clinical practice.