Total tumor diameter is a better indicator of multifocal papillary thyroid microcarcinoma: A propensity score matching analysis

Comparison of Tumor Diameter and Tumor Volume in Terms of Aggressive Tumor Behavior and Prognosis in Papillary Thyroid Cancer

BACKGROUND

Tumor diameter may not reflect tumor burden accurately in all cancers. In this study, we aimed to investigate the relationship between tumor volume (TV) and aggressive features and prognosis in papillary thyroid cancer (PTC).

METHODS

Patients diagnosed with single foci PTC were recruited for the study. The largest tumor diameter was considered as the primary tumor diameter. TV was calculated using the formula for an ellipsoid shape, considering the three pathologically specified dimensions. Primary tumor diameter and TV were compared in terms of aggressive tumor characteristics and prognosis.

RESULTS

The data of 118 patients were analyzed. There was no significant relationship between primary tumor diameter and lymph node metastasis (LNM), extrathyroidal extension (ETE), and vascular invasion (p > 0.05 for each). In patients with tumor diameter >2 cm, TV was negatively associated with LNM (p = 0.015). One-unit increase in TV was associated with 1.629 times greater likelihood of absence of LNM (95% CI: 1.099-2.415). When the TV was ≤5.26 cm3, the sensitivity and specificity for the presence of LNM were 88.9% and 75.8%, respectively. Again in this group, the sensitivity for the occurrence of ETE was 100.0% and specificity was 45.7% when the TV was ≤9.49 cm3. There was no significant difference in the five-year disease-free survival between tumor diameter and TV.

CONCLUSIONS

In contrary to studies with other cancer types in the literature, there was a significant but negative relationship between TV and LNM. Further large-scale studies are needed to determine whether TV can be used as a prognostic factor in PTC.

Pretreatment level of circulating tumor cells is associated with lymph node metastasis in papillary thyroid carcinoma patients with ≤ 55 years old

OBJECTIVE

To investigate the relationship of pretreatment of circulating tumor cells (CTCs) and cervical lymph node metastasis (LNM) (central LNM (CLNM) and lateral LNM (LLNM)) in papillary thyroid carcinoma (PTC) patients with ≤ 55 years old.

METHODS

Clinicopathological data (CTCs level, Hashimoto's thyroiditis, thyroid function, multifocal, tumor size, invaded capsule, clinical stage, and LNM) of 588 PTC patients with ≤ 55 years old were retrospectively collected. The relationship of CLNM, LLNM and the clinical features of patients was analyzed. Univariate and multivariate logistic regression analyses were used to evaluate the relationship between the CTCs and CLNM, LLNM.

RESULTS

There were 273(46.4%) and 89(15.1%) patients with CLNM and LLNM, respectively. Patients with CLNM had higher proportions of multifocality, tumor size > 1 cm, invaded capsule, and positive CTCs level than those without (all p < 0.05). Patients with LLNM had higher proportions of multifocality, tumor size > 1 cm, and invaded capsule than those without (all p < 0.05). Logistic regression analysis showed that multifocality (odds ratio (OR): 1.821, 95% confidence interval (CI): 1.230-2.698, p = 0.003), tumor size > 1 cm (OR: 3.444, 95% CI: 2.296-5.167, p < 0.001), invaded capsule (OR: 1.699, 95% CI: 1.167-2.473, p = 0.006), and positive CTCs level (OR: 1.469, 95% CI: 1.019-2.118, p = 0.040) were independently associated with CLNM; and multifocality (OR: 2.373, 95% CI: 1.389-4.052, p = 0.002), tumor size > 1 cm (OR: 5.344, 95% CI: 3.037-9.402, p < 0.001), and invaded capsule (OR: 2.591, 95% CI: 1.436-4.674, p = 0.002) were independently associated with LLNM.

CONCLUSIONS

Preoperative CTCs positive was associated with CLNM in PTC patients with ≤ 55 years old, but not LLNM.

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas

(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs > 10 mm, TTDs ≤ 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.

The value of total tumor diameter in unilateral multifocal papillary thyroid carcinoma: a propensity score matching analysis

Background

Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC). However, the maximum tumor diameter (MTD), currently utilized in various staging schemes, might not accurately indicate the level of aggressiveness exhibited by multifocal tumors. We aimed to investigate the relationship between total tumor diameter (TTD) and clinicopathological features of papillary thyroid carcinoma.

Methods

Retrospective data analysis was done on 1936 individuals who underwent complete thyroidectomy for PTC. Patients were classified into subgroups according to unilateral multifocality, central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). The relationships of clinicopathological features among these groups were analyzed.

Results

Unilateral multifocality was observed in 117 patients. The clinicopathological features of the unilateral multifocal PTC were similar to the unifocal PTC with approximate TTD. The unilateral multifocality played no independent role in CLNM and LLNM. Moreover, the efficiency of TTD in predicting CLNM and LLNM was significantly higher than that of MTD.

Conclusion

In the case of unilateral multifocal PTC, TTD is a more accurate indicator of the biological characteristics of the tumor than MTD.

Nomogram prediction for cervical lymph node metastasis in multifocal papillary thyroid microcarcinoma

Aim

Accurate preoperative prediction of cervical lymph node metastasis (LNM) in patients with mPTMC provides a basis for surgical decision making and the extent of tumor resection. This study aimed to develop and validate an ultrasound radiomics nomogram for the preoperative assessment of LN status.

Methods

A total of 450 patients pathologically diagnosed with mPTMC were enrolled, including 348 patients in the modeling group and 102 patients in the validation group. Univariate and multivariate logistic regression analyses were performed on the basic information, ultrasound characteristics, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scores of the patients in the modeling group to identify independent risk factors for LNM in mPTMC and to construct a logistic regression equation and nomogram to predict the risk of LNM. The validation group data were used to evaluate the predictive performance of the nomogram.

Results

Male sex, age <40 years, a single lesion with a maximum diameter >0.5 cm, capsular invasion, a maximum ACR score >9 points, and a total ACR score >19 points were independent risk factors for the development of cervical LNM in mPTMC. Both the area under the curve (AUC) and concordance index (C-index) of the prediction model constructed from the above six factors were 0.838. The calibration curve of the nomogram was close to the ideal diagonal line. Furthermore, decision curve analysis (DCA) demonstrated a significantly greater net benefit of the model. The external validation demonstrated the reliability of the prediction nomogram.

Conclusions

The presented radiomics nomogram, which is based on ACR TI-RADS scores, shows favorable predictive value for the preoperative assessment of LNs in patients with mPTMC. These findings may provide a basis for surgical decision making and the extent of tumor resection.