The Prognostic Values of Preoperative Tumor Volume and Tumor Diameter in T1N0 Papillary Thyroid Cancer

Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study

BACKGROUND

Several trace minerals have been shown to be associated with thyroid cancer. Democratic Republic of Congo (DRC) is deemed the most mineral-rich country globally. Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.

AIM

To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.

METHODS

We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga, South Kivu and Kinshasa between 2005 and 2019. Of these three provinces, Katanga and South Kivu have the highest mineral density with the DRC.

RESULTS

Mean patient age was 44.2 years ± 14.6 years with a female predominance, with a female to male ratio of 5.4. The 66.5% of patients had a family history of thyroid disease. Total 74 patients had simple nodules, and the remaining 455 patients had multiple nodules. The 87.7% of patients were euthyroid. The nodules exhibited varying characteristics namely hypoechogenicity (84.5%), solid echostructure (72.2%), macronodular appearance (59.8%), calcifications (14.4%) and associated lymphadenopathy (15.5%). The 22.3% of the nodules were malignant. Factors independently associated with malignancy were older age (≥ 60 years) [adjusted odds ratio (aOR) = 2.81], Katanga province (aOR = 8.19), solid echostructure (aOR = 7.69), hypoechogenicity (aOR = 14.19), macronodular appearance (aOR = 9.13), calcifications (aOR = 2.6) and presence of lymphadenopathy (aOR = 6.94).

CONCLUSION

Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant. Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.

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.

Recommendation for Clinical T Staging in Patients with Non-Small Cell Lung Cancer: Volumetric Measurement: A Retrospective Study from Turkey

Background

Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes-such as spherical, amorphous, or spiculated tumors- can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter- based T staging and to conduct comparative survival analyses between these methods.

Methods

We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test.

Results

The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage.

Conclusion

T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Background

The occurrence of cervical lymph node metastasis in T1 stage papillary thyroid carcinoma (PTC) is frequently observed. Notably, lateral lymph node metastasis (LLNM) emerges as a critical risk factor adversely affecting prognostic outcomes in PTC. The primary aim of this investigation was to delineate the risk factors associated with LLNM in the initial stages of PTC.

Methods

This retrospective analysis encompassed 3,332 patients diagnosed with T1 stage PTC without evident LLNM at the time of diagnosis. These individuals underwent primary surgical intervention at West China Hospital, Sichuan University between June 2017 and February 2023. The cohort was divided into two groups: patients manifesting LLNM and those without metastasis at the time of surgery. Additionally, T1 stage PTC patients were subdivided into T1a and T1b categories. Factors influencing LLNM were scrutinized through both univariate and multivariate analyses.

Results

The incidence of LLNM was observed in 6.2% of the cohort (206 out of 3,332 patients). Univariate analysis revealed significant correlations between LLNM and male gender (P<0.001), tumor localization in the upper lobe (P<0.001), maximal volume of the primary tumor (P<0.001), largest tumor diameter (P<0.001), multifocality (P<0.001), and bilaterality (P<0.001), with the exception of age (P=0.788) and duration of active surveillance (AS) (P=0.978). Multivariate logistic regression analysis identified male gender (P<0.001), upper lobe tumor location (P<0.001), maximal primary tumor volume (P<0.001), and multifocality (P<0.001) as independent predictors of LLNM. However, age categories (≤55, >55 years), maximum tumor diameter, bilaterality, and surveillance duration did not exhibit a significant impact. Comparative analyses between T1a and T1b subgroups showed congruent univariate results but revealed differences in multivariate outcomes. In the T1a subgroup, gender, tumor location, and multifocality (all P<0.05) were associated with elevated LLNM risk. Conversely, in the T1b subgroup, tumor location, dimensions, and multifocality (all P<0.05) were significant predictors of LLNM risk, whereas gender (P=0.097) exerted a marginal influence.

Conclusions

The investigation highlights several key risk factors for LLNM in T1 stage PTC patients, including gender, upper lobe tumor location, larger tumor size, and multifocality. Conversely, prolonged AS and younger age did not significantly elevate LLNM risk, suggesting the viability of AS as a strategic option in selected cases.

Prognostic value of the ratio of pretreatment carcinoembryonic antigen to tumor volume in rectal cancer

BACKGROUND

As a commonly used biomarker in rectal cancer (RC), the prognostic value of carcinoembryonic antigen (CEA) remains underexplored. This study aims to evaluate the prognostic value of pretreatment CEA/tumor volume in RC.

METHODS

This retrospective study included patients who underwent pretreatment magnetic resonance imaging (MRI) with histologically confirmed primary rectal adenocarcinoma from November 2012 to April 2018. Patients were divided into high-risk and low-risk groups according to the median values of CEA/Diapath (CEA to pathological diameter), CEA/DiaMRI (CEA to MRI tumor diameter), and CEA/VolMRI (CEA to MRI tumor volume). Cox regression analysis was utilized to determine the prognostic value of CEA, CEA/Diapath, CEA/DiaMRI, and CEA/VolMRI. Stepwise regression was used to establish nomograms for predicting disease-free survival (DFS) and overall survival (OS). Predictive performance was estimated by using the concordance index (C-index) and area under curve receiver operating characteristic (AUC).

RESULTS

A total of 343 patients [median age 58.99 years, 206 (60.06%) males] were included. After adjusting for patient-related and tumor-related factors, CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in distinguishing high-risk from low-risk patients in terms of DFS [hazard ratio (HR) =1.83; P=0.010] and OS (HR =1.67; P=0.048). Subanalysis revealed that CEA/VolMRI stratified high death risk in CEA-negative individuals (HR =2.50; P=0.038), and also stratified low recurrence risk in CEA-positive individuals (HR =2.06; P=0.024). In the subanalysis of stage II or III cases, the highest HRs and the smallest P values were observed in distinguishing high-risk from low-risk patients according to CEA/VolMRI in terms of DFS (HR =2.44; P=0.046 or HR =2.41; P=0.001) and OS (HR =1.96; P=0.130 or HR =2.22; P=0.008). The nomograms incorporating CEA/VolMRI showed good performance, with a C-index of 0.72 [95% confidence interval (CI): 0.68-0.79] for DFS and 0.73 (95% CI: 0.68-0.80) for OS.

CONCLUSIONS

Higher CEA/VolMRI was associated with worse DFS and OS. CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in predicting DFS and OS. Pretreatment CEA/VolMRI may facilitate risk stratification and treatment decision-making.

Tumour volume is a predictor of lymphovascular invasion in differentiated small thyroid cancer

Objectives

For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease, defined by lymphovascular invasion (LVI) than a traditional single measurement of diameter. We aimed to investigate the relationship between tumour diameter, volume and associated LVI.

Methods

Differentiated thyroid cancers (DTC) ≤ 2 cm surgically resected between 2007 and 2016 were analysed. Volume was calculated using the formula for an ellipsoid shape from pathological dimensions. A 'larger volume' cut-off was established by receiver operating characteristic (ROC) analysis using the presence of lateral cervical lymph node metastasis (N1b). Logistic regression was performed to compare the 'larger volume' cut-off to traditional measurements of diameter in the prediction.

Results

During the study period, 2405 DTCs were surgically treated and 523 met the inclusion criteria. The variance of tumour volume relative to diameter increased exponentially with increasing tumour size; the interquartile ranges for the volumes of 10, 15 and 20 mm diameter tumours were 126, 491 and 1225 mm^3, respectively. ROC analysis using volume to predict N1b disease established an optimal volume cut-off of 350 mm³ (area under curve = 0.59, P = 0.02) as 'larger volume'. 'Larger volume' DTC was an independent predictor for LVI in multivariate analysis (odds ratio (OR) = 1.7, P = 0.02), whereas tumour diameter > 1 cm was not (OR = 1.5, P = 0.13). Both the volume > 350 mm³ and dimension > 1 cm were associated with greater than five lymph node metastasis and extrathyroidal extension.

Conclusion

In this study for small DTCs ≤ 2 cm, the volume of >350 mm³ was a better predictor of LVI than greatest dimension > 1 cm.

Prognostic impact of dimensional factors in pT1 gastric cancer

BACKGROUND

The significance of the dimensional factors (tumor diameter, area and volume) as the prognostic factor has not been precisely evaluated in pT1 gastric cancer.

OBJECTIVES

This study aimed to identify the clinical impact and to confirm the clinical feasibility of the dimensional factors as prognostic factors in pT1 gastric cancer.

METHODS

We analyzed prognostic factors for disease-specific survival (DSS), overall survival (OS) using clinicopathological factors by univariate and multivariate analyses and the pattern of recurrence in 2011 pT1 gastric cancer (mucosal and submucosal cancers) undergoing R0 gastrectomy. The cut-off values of each dimensional factor was decided by the ROC curve.

RESULTS

Cox proportional hazard regression model showed that older age (≥75) and more advanced pN stage were adverse independent prognostic factors for DSS, and revealed that older age (≥75), greater preoperative co-morbid diseases, proximal and total gastrectomy, operative method and Clavien-Dindo classification (≥grade III) were independent adverse factors for OS. Any dimensional factors were not independent prognostic factors for any survival.

CONCLUSIONS

The dimensional factors do not influence both OS and DSS in pT1 gastric cancer patients and so it is difficult to apply these dimensional factors for conducting therapeutic strategies.

MicroRNA-30a suppresses papillary thyroid cancer cell proliferation, migration and invasion by directly targeting E2F7

microRNA (miRNA/miR)-30a, a tumor-associated miRNA, has been implicated in the tumorigenesis and progression of different types of human cancer. Thyroid cancer is a common endocrine malignancy, of which papillary thyroid cancer (PTC) accounts for ~80-90% of all TC. However, the effect of miR-30a in PTC is yet to be fully elucidated. The TPC-1 human PTC cell line, as well as the normal human thyroid cell line (HT-ori3), were utilized in the current study. The PTC cell line was transfected with a miR-30a mimic. Subsequently, reverse transcription-quantitative polymerase chain reaction was performed to detect the expression of miR-30a and E2F transcription factor 7 (E2F7). Cell proliferation was assessed via a MTT assay and transwell migration and invasion assays were performed to detect the migration and invasion of PTC cells. A dual-luciferase reporter assay was also utilized to clarify the association between miR-30a and E2F7. The results of the current study revealed that miR-30a was significantly downregulated in TPC-1 cells compared with HT-ori3 cells and that the expression of E2F7 was significantly upregulated in PTC cells. The upregulation of miR-30a also inhibited the proliferation, migration and invasion of PTC cells. Furthermore, the luciferase assay revealed that miR-30a binds to the 3'-UTR of E2F7. Additionally, the overexpression of miR-30a decreased E2F7 levels in TPC-1 cells. These results indicate that miR-30a functions as a tumor suppressor in PTC by direct targeting E2F7 and that miR-30a may be a novel therapeutic target for patients with PTC.

Prognostic influence of 3-dimensional tumor volume on breast cancer compared to conventional 1-dimensional tumor size

Purpose

The prognostic influence of 3-dimensional tumor volume (Tv) on breast cancer compared to conventional 1-dimensional tumor size (T) was investigated.

Methods

Analysis was performed on a cohort of 8,996 primary breast cancer patients who were initially diagnosed with TNM stage I–III. Tumor size was defined as the maximum tumor dimension, and Tv was calculated by the equation of (4π × r1 × r2 × r3)/3; r1, r2, and r3 were defined as half of the largest, intermediate, and shortest dimension of the tumor, respectively. Tv was classified into Tv1, Tv2, and Tv3 according to the cut off values of 2.056 cm³ and 20.733 cm³.

Results

The survival curves according to both the T and Tv categories were clearly differentiated (all P < 0.001), as were those for staging by T and Tv (all P < 0.001). In T1 and T2 tumors, the Tv1 group showed superior survival over the Tv2 group (T1, P < 0.001; T2, P = 0.001). Univariate and multivariate analysis both indicated that Tv was a significant prognostic factor (both P < 0.001). The receiver operating characteristic curve showed that the area under the curves were 0.712 (P < 0.001) for Tv and 0.699 (P < 0.001) for T. Positive correlations were observed between the number of positive nodes and T (coefficient = 0.325; P < 0.001), and between the number of positive nodes and Tv (coefficient = 0.321; P < 0.001).

Conclusion

Tv classification works well for predicting the prognosis of breast cancer, and it is a better predictor than conventional T classification in several aspects. Further studies are needed to validate the practical usefulness of Tv classification in clinical settings.

Measurement of tumor volume is not superior to diameter for prediction of lymph node metastasis in early gastric cancer with minute submucosal invasion

Background/Aim

The current indication for endoscopic resection in early gastric cancer (EGC) with minute (< 500 µm) submucosal invasion is based on tumor diameter, which may be insufficient to predict lymph node metastasis (LNM). We investigated whether tumor volume might more accurately predict LNM in EGC with minute submucosal invasion.

Materials and Methods

Among patients who underwent gastrectomy for gastric cancer, 346 with well/moderately differentiated EGC with submucosal invasion <500 µm were evaluated. Three-dimensional tumor volume was calculated using an endoscopically resected specimen and compared with 1-dimensional tumor diameter. Predictive ability of tumor diameter or volume for LNM was evaluated using receiver operating characteristic curve analysis.

Results

Tumor diameter and volume predicted LNM with an area under the curve (AUC) of 0.567 and 0.589, respectively. AUC, sensitivity, specificity, positive and negative predictive values, and accuracy of the 2 models were not significantly different. Tumor diameter ≥ 3 cm showed a significant association with LNM (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.01–6.57; P = 0.049), whereas a tumor volume cutoff value of 752.8 cm3 showed no significant association with LNM (OR, 1.52; 95% CI, 0.59–3.88; P = 0.385).

Conclusions

Tumor volume had no advantage over diameter for predicting LNM in well/moderately differentiated EGC with minute submucosal invasion.

Periostin silencing suppresses the aggressive phenotype of thyroid carcinoma cells by suppressing the Akt/thyroid stimulating hormone receptor axis

Clinical evidence indicates that high periostin expression correlates with aggressive phenotype in thyroid carcinoma. However, the biological roles of periostin in thyroid carcinoma development and progression are still unclear. In this study, we explored the effects of periostin silencing on thyroid carcinoma cell growth, invasion, and tumorigenesis. We also studied the impact of periostin on the activation of phosphoinositide 3-kinase (PI3-K)/Akt signaling, which is involved in the pathogenesis of thyroid carcinoma. It was found that downregulation of periostin significantly inhibited the proliferation, colony formation, and invasion in both FTC-133 and BCPAP thyroid carcinoma cells. In vivo tumorigenic studies confirmed that periostin depletion retarded the growth of subcutaneous FTC-133 xenograft tumors, which was coupled with a significant decline in the percentage of Ki-67-positive proliferating cells. Western blot analysis demonstrated that periostin downregulation caused a marked inhibition of thyroid stimulating hormone receptor (TSHR) expression and Akt phosphorylation in FTC-133 and BCPAP cells. Co-expression of constitutively active Akt (CA-Akt) significantly reversed periostin-mediated downregulation of TSHR. Most importantly, overexpression of TSHR or CA-Akt rescued FTC-133 cells from periostin-induced growth and invasion suppression. Collectively, periostin regulates thyroid carcinoma growth and progression via the Akt/TSHR axis and represents a promising therapeutic target for this malignancy.