Prognostic Value of Serum Free Thyroxine and Composite Modeling for Postoperative Short-term Poor Prognosis in Patients with Craniopharyngioma

JIANG Jin; QU Hong; FENG Sizhe; YU Chunyong; HAN Hongguang; DU Jinwei; GONG Yanyu

doi:10.13730/j.issn.2097-2148.2024.08.005

Abstract：Objective To investigate the predictive value of serum free triiodothyronine(FT4)and composite mod-eling for postoperative short-term poor prognosis in patients with craniopharyngioma(CP).Methods The postoperative clinical data of 95 patients with CP admitted to the author's hospital from January 2018 to November 2023 were retrospec-tively analyzed,and the patients were divided into good prognosis group[Karnofsky(KPS)＞7,n=46]and poor prog-nosis group(KPS≤7,n=49)according to the KPS score of the follow-up visit at 3 months ofter discharge.Clinical data of the two groups were collected,including age,gender,body mass index(BMI),hypertension,diabetes mellitus,diabe-tes insipidus,tumor size and laboratory endocrine related tests,the influencing factors of poor prognosis of CP patients were analyzed by binary Logistic regression,a composite model predicting the poor prognosis in the short-term postopera-tive period in patients with CP was constructed.The predictive value of postoperative FT4 and the composite model for postoperative prognosis in CP patients was assessed using the receiver operator characteristic(ROC),restricted cubic spline(RCS)and decision curve.Results Univariate analysis showed that there were significant differences in age,tumor size,BMI,diabetes insipidus,preoperative C-reactive protein and postoperative serum FT4 between the two groups(all P＜0.05);the results of binary Logistic regression analysis showed that big tumor,BMI and diabetes insipidus were independent risk factors affecting poor short-term postoperative prognosis in CP patients(all P＜0.05),while the postoperative FT4 was a protective factor(P＜0.05).The ROC area under the curve(AUC)of postoperative FT4 and composite model for predicting poor short-term prognosis in CP patients was 0.732(95％CI:0.622-0.842)and 0.972(95％CI:0.909-1.000),respectively.The strength of association between postoperative FT4 and short-term poor prognosis showed a nonlinear dose-response relationship(P＜0.01).Decision curve results showed a higher net benefit of the composite model over postop-erative FT4 at threshold probabilities of 0.00-0.90.Conclusion Big tumor size,BMI and diabetes insipidus are independ-ent risk factors for poor short-term prognosis of CP patients after surgery,and FT4 is its protective factor.Composite model can predict the CP patients more than postoperative FT4 short-term prognosis after surgery.