Vikneson Krishna, Haniff Tariq, Thwin May, Aniss Ahmad, Papachristos Alex, Sywak Mark, Glover Anthony
Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.
Endocr Oncol. 2022 Sep 22;2(1):42-49. doi: 10.1530/EO-22-0066. eCollection 2022 Jan.
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.
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.
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 respectively. ROC analysis using volume to predict N1b disease established an optimal volume cut-off of 350 mm (area under curve = 0.59, = 0.02) as 'larger volume'. 'Larger volume' DTC was an independent predictor for LVI in multivariate analysis (odds ratio (OR) = 1.7, = 0.02), whereas tumour diameter > 1 cm was not (OR = 1.5, = 0.13). Both the volume > 350 mm and dimension > 1 cm were associated with greater than five lymph node metastasis and extrathyroidal extension.
In this study for small DTCs ≤ 2 cm, the volume of >350 mm was a better predictor of LVI than greatest dimension > 1 cm.
对于小甲状腺癌（≤2cm），肿瘤体积可能比传统的单一径线测量能更好地预测由脉管侵犯（LVI）所定义的侵袭性疾病。我们旨在研究肿瘤直径、体积与相关LVI之间的关系。
分析2007年至2016年间手术切除的直径≤2cm的分化型甲状腺癌（DTC）。根据病理尺寸，使用椭球体公式计算体积。通过采用侧颈淋巴结转移（N1b）情况的受试者操作特征（ROC）分析来确定“较大体积”的临界值。进行逻辑回归以比较“较大体积”临界值与传统直径测量值在预测方面的差异。
在研究期间，2405例DTC接受了手术治疗，523例符合纳入标准。肿瘤体积相对于直径的方差随肿瘤大小增加呈指数增长；直径为10mm、15mm和20mm肿瘤的体积四分位数间距分别为126mm、491mm和1225mm。使用体积预测N1b疾病的ROC分析确定最佳体积临界值为350mm（曲线下面积=0.59，P=0.02）作为“较大体积”。在多变量分析中，“较大体积”的DTC是LVI的独立预测因素（比值比（OR）=1.7，P=0.02），而肿瘤直径>1cm则不是（OR=1.5，P=0.13）。体积>350mm和径线>1cm均与大于5个淋巴结转移及甲状腺外侵犯相关。
在本研究中，对于直径≤2cm的小DTC，体积>350mm比最大径线>1cm是更好的LVI预测指标。
