To systematically review and critically appraise multivariable prediction models for structural postoperative recurrence in pathologically confirmed PTC and to evaluate their predictive performance, methodological quality, and risk of bias.
Approach:
Search Strategy: A systematic search was conducted in PubMed, Embase, and the Cochrane Library from inception to February 2026, focusing on studies developing or validating multivariable prediction models for structural recurrence in adult patients with PTC.
Data Extraction: Data extraction was guided by the CHARMS checklist, and risk of bias was assessed using PROBAST.
Synthesis of Findings: Findings were synthesized narratively, and an exploratory meta-analysis of discrimination performance from validation studies was conducted where appropriate.
Key Findings:
Thirteen retrospective studies met the inclusion criteria, all conducted in East Asian populations.
Reported discrimination was generally acceptable, with most AUC or C-index values exceeding 0.70.
All studies had a high overall risk of bias due to limitations in analysis, including inadequate handling of overfitting and insufficient sample size justification.
Only two studies performed external validation.
Exploratory pooling of validation AUCs suggested moderate predictive performance but substantial heterogeneity across studies.
Interpretation:
Current prediction models for structural recurrence in PTC are limited by methodological weaknesses and inadequate external validation.
Limitations:
High overall risk of bias in all studies.
Inadequate handling of overfitting and missing data.
Limited reporting of sample size justification.
Scarce external validation.
Conclusion:
Future studies should adopt standardized recurrence definitions and improve reporting transparency before routine clinical implementation.
