Prognostic factors and conditional survival analysis in primary thyroid lymphoma: a retrospective cohort study using the Surveillance, Epidemiology, and End Results database.
- 1Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China.
Abstract
Primary thyroid lymphoma (PTL) is a rare thyroid malignancy of which its time-dependent mortality risk and dynamic prognostic patterns remain poorly characterized. Traditional survival estimates provide only a static prediction at diagnosis and do not account for the changing risk profile as patients survive longer. This limitation undermines their utility in guiding long-term surveillance and individualized clinical decision-making for PTL patients. Therefore, this study aimed to utilize the Surveillance, Epidemiology, and End Results (SEER) database to conduct retrospective cohort and conditional survival analyses of PTL, quantify the time-varying mortality risk, and identify dynamic prognostic factors to support personalized long-term follow-up strategies for patients with primary thyroid lymphoma. This retrospective cohort study utilized data from the SEER database [2000-2018]. Patients with pathologically confirmed PTL were included, and those with unknown stage, incomplete follow-up, unknown survival time, or a history of other malignancies were excluded. The primary endpoint was disease-specific survival (DSS), defined as time from diagnosis to death attributable to PTL. Kaplan-Meier methods, log-rank tests, and univariate and multivariate Cox proportional hazards regression were used to identify independent prognostic factors. Conditional survival probabilities were calculated using life-table methods, and annual mortality hazards were estimated using piecewise exponential models. A total of 1,587 patients were included. Multivariable Cox regression identified age ≥60 years [hazard ratio (HR) =0.216, 95% confidence interval (CI): 0.138-0.337, P<0.001], advanced tumor stage (regional vs. localized: HR =0.580, 95% CI: 0.389-0.866, P=0.008; distant vs. localized: HR =0.944, 95% CI: 0.637-1.400, P=0.045), and absence of radiotherapy (HR =0.636, 95% CI: 0.468-0.865, P=0.004) as independent predictors of poorer DSS. The annual mortality hazard declined steeply within the first five years after diagnosis and plateaued thereafter. Conditional DSS improved progressively with each additional year survived, with the most pronounced improvements observed among elderly patients (≥60 years) and those who did not receive radiotherapy. Conditional survival analysis provides dynamic, time-updated prognostic information that complements traditional static estimates. These findings support integrating conditional survival assessment into routine follow-up counseling, particularly for high-risk subgroups, to facilitate more personalized long-term surveillance and management strategies for PTL patients.
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BibTeX
@article{liu2026prognostic,
title = {{Prognostic factors and conditional survival analysis in primary thyroid lymphoma: a retrospective cohort study using the Surveillance, Epidemiology, and End Results database.}},
author = {Pai Liu and Chengzhou Lv and Yang Shi and Yuenan Zheng and Hao Zhang and Wenwu Dong and Ping Zhang},
journal = {Gland surgery},
year = {2026},
month = sep,
doi = {10.21037/gs-2026-0221},
url = {https://europepmc.org/article/MED/42996880},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prognostic factors and conditional survival analysis in primary thyroid lymphoma: a retrospective cohort study using the Surveillance, Epidemiology, and End Results database.
AU - Pai Liu
AU - Chengzhou Lv
AU - Yang Shi
AU - Yuenan Zheng
AU - Hao Zhang
AU - Wenwu Dong
AU - Ping Zhang
PY - 2026
DA - 2026/09/28
JO - Gland surgery
DO - 10.21037/gs-2026-0221
UR - https://europepmc.org/article/MED/42996880
AB - Primary thyroid lymphoma (PTL) is a rare thyroid malignancy of which its time-dependent mortality risk and dynamic prognostic patterns remain poorly characterized. Traditional survival estimates provide only a static prediction at diagnosis and do not account for the changing risk profile as patients survive longer. This limitation undermines their utility in guiding long-term surveillance and individualized clinical decision-making for PTL patients. Therefore, this study aimed to utilize the Surveillance, Epidemiology, and End Results (SEER) database to conduct retrospective cohort and conditional survival analyses of PTL, quantify the time-varying mortality risk, and identify dynamic prognostic factors to support personalized long-term follow-up strategies for patients with primary thyroid lymphoma. This retrospective cohort study utilized data from the SEER database [2000-2018]. Patients with pathologically confirmed PTL were included, and those with unknown stage, incomplete follow-up, unknown survival time, or a history of other malignancies were excluded. The primary endpoint was disease-specific survival (DSS), defined as time from diagnosis to death attributable to PTL. Kaplan-Meier methods, log-rank tests, and univariate and multivariate Cox proportional hazards regression were used to identify independent prognostic factors. Conditional survival probabilities were calculated using life-table methods, and annual mortality hazards were estimated using piecewise exponential models. A total of 1,587 patients were included. Multivariable Cox regression identified age ≥60 years [hazard ratio (HR) =0.216, 95% confidence interval (CI): 0.138-0.337, P<0.001], advanced tumor stage (regional vs. localized: HR =0.580, 95% CI: 0.389-0.866, P=0.008; distant vs. localized: HR =0.944, 95% CI: 0.637-1.400, P=0.045), and absence of radiotherapy (HR =0.636, 95% CI: 0.468-0.865, P=0.004) as independent predictors of poorer DSS. The annual mortality hazard declined steeply within the first five years after diagnosis and plateaued thereafter. Conditional DSS improved progressively with each additional year survived, with the most pronounced improvements observed among elderly patients (≥60 years) and those who did not receive radiotherapy. Conditional survival analysis provides dynamic, time-updated prognostic information that complements traditional static estimates. These findings support integrating conditional survival assessment into routine follow-up counseling, particularly for high-risk subgroups, to facilitate more personalized long-term surveillance and management strategies for PTL patients.
SN - 2227-684X
SN - 2227-8575
ER -