Predictors of poor prognosis in long-term survivors of differentiated thyroid cancer with psychiatric disorders

Table 1 Comparison of clinical features of patients in different groups, mean ± SD/n (%)

Clinical feature	Total number of patients (n = 108)	Thyroid cancer group (n = 48)	Benign nodule group (n = 30)	Mental disorder group (n = 30)	χ2/F	P value
Age (years)	56.27 ± 6.51	56.67 ± 6.25	56.17 ± 7.06	55.76 ± 6.58	0.183	0.833
Gender					0.158	0.924
Male	50 (46.30)	23 (47.92)	13 (43.33)	14 (46.67)
Female	58 (53.70)	25 (52.08)	17 (56.67)	16 (53.33)
BMI (kg/m2)	23.21 ± 3.48	23.11 ± 3.57	23.26 ± 3.62	23.35 ± 3.29	0.046	0.955
Smoking history	24 (22.22)	14 (29.17)	6 (20.00)	4 (13.33)	2.796	0.247
Drinking history	32 (29.63)	19 (39.58)	7 (23.33)	6 (20.00)	4.185	0.123
Duration of mental disorders (years)	3.48 ± 0.62	3.54 ± 0.21	3.49 ± 0.32	3.41 ± 0.24	2.440	0.092
FT3 (pmol/L)	16.20 ± 4.66	18.96 ± 2.54	16.25 ± 5.33	11.75 ± 2.85	36.979	0.000
FT4 (pmol/L)	38.87 ± 20.20	52.23 ± 18.41	39.52 ± 12.33	16.85 ± 2.65	59.105	0.000
TSH (mU/L)	2.94 ± 0.47	2.96 ± 0.46	2.89 ± 0.54	2.94 ± 0.41	0.206	0.814
TT3 (nmol/L)	2.04 ± 0.28	2.03 ± 0.24	2.05 ± 0.28	2.04 ± 0.19	0.065	0.937
TT4 (nmol/L)	107.58 ± 21.31	106.33 ± 22.41	111.31 ± 19.63	105.85 ± 21.36	0.637	0.531
ALT (U/L)	27.73 ± 10.81	32.65 ± 11.52	28.45 ± 7.69	19.13 ± 6.34	19.555	0.000
AST (U/L)	27.75 ± 5.38	28.13 ± 5.65	27.95 ± 4.98	26.95 ± 5.41	0.468	0.628
ALP (U/L)	84.27 ± 22.42	87.15 ± 21.74	84.96 ± 22.14	78.98 ± 23.54	1.252	0.290
TBil (μmol/L)	15.86 ± 5.69	18.13 ± 5.58	16.23 ± 4.16	11.85 ± 5.11	14.151	0.000
TP (g/L)	72.76 ± 5.76	73.26 ± 6.35	72.99 ± 5.18	71.72 ± 5.34	0.691	0.504
ALB (g/L)	43.22 ± 5.84	41.54 ± 6.94	43.79 ± 5.29	45.33 ± 3.18	4.345	0.015
Cortisol (nmol/L)	178.77 ± 28.43	198.41 ± 16.98	179.87 ± 14.13	146.23 ± 24.11	72.976	0.000
NE (ng/L)	277.50 ± 69.03	326.85 ± 56.31	249.85 ± 44.18	226.17 ± 54.25	39.491	0.000
Ang II (ng/mL)	18.89 ± 5.84	23.68 ± 4.98	15.79 ± 2.54	14.32 ± 3.15	64.523	0.000
SOD (nU/mL)	92.99 ± 22.98	76.25 ± 6.21	95.34 ± 6.41	117.41 ± 27.54	66.166	0.000

BMI: Body mass index; FT3: Serum free T3; FT4: Serum free T4; TSH: Thyroid stimulating hormone; TT3: Total triiodothyronine; TT4: Total thyroxine; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; TBil: Total bilirubin; TP: Total protein; ALB: Albumin; NE: Norepinephrine; Ang II: Angiotensin II; SOD: Superoxide dismutase.

Table 2 Comparison of clinical features of thyroid cancer patients with different prognoses, mean ± SD/n (%)

Clinical feature	Total number of patients (n = 48)	Good prognosis group (n = 38)	Poor prognosis group (n = 10)	χ2/t	P value
Age (years)	56.67 ± 6.25	57.21 ± 6.17	54.60 ± 6.47	1.179	0.245
Gender				0.254	0.614
Male	23 (47.92)	17 (44.74)	6 (60.00)
Female	25 (52.08)	21 (55.26)	4 (40.00)
BMI (kg/m2)	23.11 ± 3.57	22.92 ± 3.50	23.81 ± 3.95	0.697	0.489
Tumour duration (months)	18.15 ± 2.32	18.34 ± 2.13	17.40 ± 2.84	1.157	0.253
Incidence side				1.044	0.307
Unilateral	37 (77.08)	31 (81.58)	6 (60.00)
Bilateral	11 (22.92)	7 (18.42)	4 (40.00)
Pathological type				2.695	0.101
Papillocarcinoma	36 (75.00)	31 (81.58)	5 (50.00)
Lecarcinome folliculaire	12 (25.00)	7 (18.42)	5 (50.00)
Number of lesions				0.393	0.531
Single	21 (43.75)	18 (47.37)	3 (30.00)
Multiple	27 (56.25)	20 (52.63)	7 (70.00)
Tumour diameter (cm)	2.71 ± 0.84	2.48 ± 0.73	3.62 ± 0.62	4.519	0.000
T stage				5.013	0.025
T1-T2	27 (56.25)	25 (65.79)	2 (20.00)
T3-T4	21 (43.75)	13 (34.21)	8 (80.00)
Lymph node metastasis	42 (87.50)	34 (89.47)	8 (80.00)	0.072	0.788
Extra-glandular infiltration	6 (12.50)	1 (2.63)	5 (50.00)	12.199	0.001
Degree of differentiation				8.181	0.004
Moderate-high differentiation	43 (89.58)	37 (97.37)	6 (60.00)
Low differentiation	5 (10.42)	1 (2.63)	4 (40.00)
FT3 (pmol/L)	18.96 ± 2.54	18.04 ± 1.86	22.45 ± 1.47	6.931	0.000
FT4 (pmol/L)	52.23 ± 18.41	46.77 ± 15.04	72.96 ± 15.42	4.875	0.000
TSH (mU/L)	2.96 ± 0.46	2.97 ± 0.48	2.95 ± 0.42	0.120	0.905
TT3 (nmol/L)	2.03 ± 0.24	2.03 ± 0.27	2.06 ± 0.14	0.338	0.737
TT4 (nmol/L)	106.33 ± 22.41	106.98 ± 21.54	103.82 ± 26.61	0.393	0.696
ALT (U/L)	32.65 ± 11.52	29.57 ± 10.15	44.37 ± 8.73	4.211	0.000
AST (U/L)	28.13 ± 5.65	27.79 ± 5.74	29.40 ± 5.43	0.797	0.429
ALP (U/L)	87.15 ± 21.74	86.58 ± 23.42	89.34 ± 14.38	0.354	0.725
TBil (μmol/L)	18.13 ± 5.58	16.34 ± 4.49	24.90 ± 3.96	5.485	0.000
TP (g/L)	73.26 ± 6.35	72.34 ± 6.08	76.79 ± 6.41	2.037	0.047
ALB (g/L)	41.54 ± 6.94	43.51 ± 6.07	34.06 ± 4.60	4.575	0.000
Cortisol (nmol/L)	198.41 ± 16.98	193.77 ± 15.47	216.07 ± 9.09	4.344	0.000
NE (ng/L)	326.85 ± 56.31	309.14 ± 43.96	394.17 ± 47.51	5.355	0.000
Ang II (ng/mL)	23.68 ± 4.98	22.22 ± 4.47	29.25 ± 1.92	4.827	0.000
SOD (nU/mL)	76.25 ± 6.21	78.35 ± 4.59	68.31 ± 5.13	6.010	0.000

BMI: Body mass index; FT3: Serum free T3; FT4: Serum free T4; TSH: Thyroid stimulating hormone; TT3: Total triiodothyronine; TT4: Total thyroxine; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; TBil: Total bilirubin; TP: Total protein; ALB: Albumin; NE: Norepinephrine; Ang II: Angiotensin II; SOD: Superoxide dismutase.

Table 3 Assignment of argument variables

Independent variable	Assign values
Tumour diameter	Original value
T stage	T1-T2 = 1, T3-T4 = 2
Lymph node metastasis	No = 0, yes = 1
Degree of differentiation	Moderate-high differentiation = 1, low differentiation = 2
FT3	Original value
FT4	Original value
TBil	Original value
TP	Original value
ALB	Original value
Cortisol	Original value
NE	Original value
Ang II	Original value
SOD	Original value

FT3: Serum free T3; FT4: Serum free T4; TBil: Total bilirubin; TP: Total protein; ALB: Albumin; NE: Norepinephrine; Ang II: Angiotensin II; SOD: Superoxide dismutase.

Table 4 Results of one-way logistics regression analysis

Independent variable	B	S.E.	Wald	P value	OR	95% confidence interval
						Lower limit	Upper limit
Tumour diameter	2.954	0.948	9.719	0.002	19.190	2.995	122.949
T stage	2.042	0.861	5.610	0.018	7.692	1.422	41.614
Lymph node metastasis	3.611	1.195	9.137	0.003	37.000	3.559	384.620
Degree of differentiation	3.205	1.202	7.117	0.008	24.667	2.341	259.933
FT3	3.107	1.389	5.001	0.025	22.348	1.468	340.259
FT4	0.147	0.048	9.467	0.002	1.158	1.055	1.272
TBil	0.583	0.202	8.330	0.004	1.792	1.206	2.663
TP	0.120	0.063	3.608	0.057	1.127	0.996	1.275
ALB	-0.393	0.134	8.617	0.003	0.675	0.520	0.878
Cortisol	0.166	0.057	8.540	0.003	1.180	1.056	1.319
NE	0.046	0.015	9.904	0.002	1.047	1.018	1.078
Ang II	0.680	0.224	9.187	0.002	1.975	1.272	3.066
SOD	-0.663	0.235	7.956	0.005	0.515	0.325	0.817

OR: Odds ratio; FT3: Serum free T3; FT4: Serum free T4; TBil: Total bilirubin; TP: Total protein; ALB: Albumin; NE: Norepinephrine; Ang II: Angiotensin II; SOD: Superoxide dismutase.

Table 5 Results of multifactorial logistics regression analysis

Independent variable	B	S.E.	Wald	P value	OR	95% confidence interval
						Lower limit	Upper limit
Tumour diameter	2.808	1.220	5.296	0.021	16.570	1.516	181.048
T stage	1.270	1.115	1.298	0.255	3.560	0.401	31.643
Lymph node metastasis	3.973	1.549	6.579	0.010	53.145	2.553	1106.354
Degree of differentiation	1.012	1.428	0.502	0.479	2.750	0.167	45.186
FT4	0.171	0.063	7.323	0.007	1.186	1.048	1.343
TBil	1.038	0.525	3.900	0.048	2.823	1.008	7.907
Cortisol	0.240	0.128	3.521	0.061	1.271	0.989	1.632
NE	0.039	0.029	1.791	0.181	1.040	0.982	1.102
Constant	-88.138	43.255	4.152	0.042	0.000

OR: Odds ratio; FT4: Serum free T4; TBil: Total bilirubin; NE: Norepinephrine.

Table 6 Receiver operating characteristic analysis results

Index	AUC	Sensitivity (%)	Specificity (%)	95% confidence interval	Youden index
Tumour diameter	0.884	80.00	94.70	0.756-1.000	0.747
Extra-glandular infiltration	0.737	50.00	97.40	0.530-0.943	0.474
FT4	0.779	60.00	89.50	0.614-0.944	0.495
TBil	0.863	70.00	89.50	0.740-0.986	0.595
Overall model	0.992	100.00	97.40	0.974-1.000	0.974

AUC: Area under the curve; FT4: Serum free T4; TBil: Total bilirubin.