Correlation Analysis of Nodular Sonographic Parameters with Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma

Background Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma, and is prone to cervical lymph node metastases (CLNM). We aim to analyze the correlation between clinical information, ultrasonic parameters of PTC and CLNM. Methods 1335 patients who had pathologically confirmed unifocal PTC were enrolled. Univariate and multivariate logistic analysis were performed to predict CLNM in PTC patients. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. Results Univariate analysis showed that gender, age, maximum tumor diameter and volume, cross-sectional and longitudinal aspect ratio were related to CLNM (P<0.05). Multivariate logistic analysis showed that gender, age, maximum tumor diameter and volume were independent correlative factors, cross-sectional aspect ratio had significant difference for PTC2 to predict CLNM. The area under the curve (AUC) of the maximum tumor diameter and volume was 0.738 and 0.733, respectively. Maximum tumor diameter and volume, and cross-sectional and longitudinal aspect ratio were statistically significant following analysis of variance (P < 0.05). Conclusions Younger age, male, and larger tumor were high risk factors for CLNM in patients with unifocal PTC. Cross-sectional aspect ratio had a more effective predictive value for CLNM in patients with larger thyroid tumors.

How Much Tumor Volume Is Responsible for Development of Clinical Symptoms in Patients With Convexity, Parasagittal, and Falx Meningiomas?

Purpose: Meningiomas are the most common primary intracranial neoplasms and clinical symptom appearance depends on their volume and location. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas.Materials and Methods: We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution.Results: The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: an asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p &lt; 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p &lt; 0.001), maximum tumor diameter (p &lt; 0.001), and tumor volume (p &lt; 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p &lt; 0.001), and tumor volume (p &lt; 0.001). The receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]).Conclusion: We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.

Clinical, Pathological, Laboratory Characteristics, and Treatment Regimens of Kimura Disease and Their Relationships With Tumor Size and Recurrence

Objective: As of date, Kimura disease (KD) has an unclear etiology, no accepted diagnostic standard, and no definite treatment regimen. In this study, clinical and pathological laboratory characteristics and treatment regimens of patients with KD with different tumor sizes and status of tumor recurrence were analyzed. This was performed to identify the factors, which determine tumor size and recurrence, and to identify effective treatment methods for patients with KD.Methods: A total of 33 hospitalized patients with a definite diagnosis of KD were enrolled in this study.Results: There were 15 patients (45.5%) with a maximum tumor diameter of &lt;3 cm. There were no statistically significant differences in age, gender, clinical symptoms, lesion sites, laboratory indicators, and treatment regimens among patients with a maximum tumor diameter &lt;3 cm or ≥3 cm (P &gt; 0.05). Among the 25 patients who completed the follow-up, there were 18 patients (72%) who had a recurrence of KD. There were no statistically significant differences in age, gender, clinical symptoms, the maximum tumor diameter, lesion sites, laboratory indicators, and initial treatment regimens between patients with or without the recurrence of KD (P &gt; 0.05). There was a statistically significant difference in systolic blood pressure (SBP) between patients with or without the recurrence of KD (P &lt; 0.05). All patients who received only surgical treatment had disease recurrence, 33.3% of patients who received prednisone therapy had no disease recurrence, and 37.5% of patients who received combination therapy showed recurrence.Conclusion: The current study summarized clinical manifestations, pathological features, laboratory indicators, and treatment regimens of patients with KD. There were no significant differences in these aspects among patients with different tumor sizes, and there was no significant difference in these aspects except in the SBP between patients with or without the recurrence of KD, indicating that SBP is a significant clinical factor affecting disease recurrence in patients. Combination therapy with prednisone was found to be superior to surgical treatment.

Correlation Analysis of Nodular Sonographic Parameters with Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

Objective Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma, and is prone to cervical lymph node metastasis (CLNM). We aim to analyze the correlation between clinical information, ultrasonic parameters of PTC and CLNM. Methods 1335 patients who had pathologically confirmed unifocal PTC were enrolled. Univariate and multivariate logistic analysis were performed to predict CLNM in PTC patients. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance. Results Univariate analysis showed that gender, age, maximum tumor diameter and volume, cross-sectional and longitudinal aspect ratio were related to CLNM (P < 0.05). Multivariate logistic analysis showed that gender, age, maximum tumor diameter and volume were independent correlative factors, cross-sectional aspect ratio had significant difference for PTC patients excluding PTMC to predict CLNM. The area under the curve (AUC) of the maximum tumor diameter and volume was 0.738 and 0.733, respectively. Maximum tumor diameter and volume, and cross-sectional and longitudinal aspect ratio were statistically significant following analysis of variance (P < 0.05). Conclusions Younger age, male, and larger tumor were high risk factors for CLNM in patients with unifocal PTC. Cross-sectional aspect ratio had a more effective predictive value for CLNM in patients with larger thyroid tumors.

Simple Ways to Estimate Meningioma Volume: Can ABC- and SH-Derived Methods Be Used in Clinical Practice Reliably?

Background. There is a clinical demand for rapid estimation of meningioma volumes. Our objective was to assess the accuracy of three ABC-derived and three SH-derived formula methods on volume estimation of meningiomas. Methods. The study group comprised 678 patients treated at our department for histopathologically proven intracranial meningiomas. For each patient, tumor volumes were independently measured using six formula methods as well as planimetry. Maximum tumor diameter and ellipsoidity were also recorded. Volumes were compared using descriptive statistics, correlation analysis, and consistency analysis. Results. Among all methods assessed, 2/3SH and 1/2ABC outperformed the others. No significant differences were found between volumes obtained by the two methods and those of planimetry ( p > 0.05 ). Spearman rank-correlation coefficients (rs) were 0.99 for both methods ( p < 0.01 ), and ICC were 0.99 and 0.98, respectively. In Bland-Altman plot, most data points lay inside the limit of agreement. Overall, 2/3SH overestimated tumor volumes by 1.29%, and estimation errors in 93.66% cases were within 20%; 1/2ABC overestimated tumor volumes by 5.36%, and estimation errors in 93.51% cases were within 30%. The performance of 2/3SH and 1/2ABC in small-volume meningiomas was slightly worse, especially for 1/2ABC. Correlations between ellipsoidity and percentage errors of 2/3SH and 1/2ABC were weak (rs = −0.06 and −0.24, respectively). Despite a significant correlation between maximum tumor diameter and planimetric volume (rs = −0.96), volumes could vary significantly for a given diameter. Conclusions. Formula methods 2/3SH and 1/2ABC can estimate meningioma volumes with decent accuracy. Compared with the 1/2ABC method, the 2/3SH method showed slightly better performance, especially in small-volume meningiomas. Ellipsoidity is not a suitable parameter to predict estimation error, and maximum tumor diameter is not a reliable surrogate for actual meningioma volume.

Clinical Outcomes of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Extremities: Analysis of Recurrence Factors

Background: Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities.Patients and Methods: The variables were evaluated as potential recurrence factor using Fisher’s exact test. The 5-year recurrence-free survival (RFS) rate was calculated using the Kaplan-Meier method, and differences in survival were assessed using a log-rank test in univariate analyses. Results: Sixty-two patients were identified, including 29 men and 33 women. The median age was 63.7 years (range, 34–82 years). The average maximum tumor diameter was 15.9 cm (range, 5–28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.049). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5–161 months).Conclusions: Tumor diameter ≥20 cm was identified as a risk factor for recurrence.

Efficacy of Liver Resection for Single Large Hepatocellular Carcinoma in Child-Pugh A Cirrhosis: Analysis of a Nationwide Cancer Registry Database

BackgroundTherapeutic strategies and good prognostic factors are important for patients with single large hepatocellular carcinoma (HCC). This retrospective study aimed to identify the prognostic factors in patients with single large HCC with good performance status and Child-Pugh A cirrhosis using a large national cancer registry database and to recommend therapeutic strategies.MethodsAmong 12139 HCC patients registered at the Korean Primary Liver Cancer Registry between 2008 and 2015, single large (≥ 5 cm) HCC patients with Eastern Cooperative Oncology Group (ECOG) performance status 0 and Child-Pugh score A were selected.ResultsOverall, 466 patients were analyzed. The 1-,2-,3-, and 5-year survival rates after initial treatment were 84.9%, 71.0%, 60.1%, and 51.6%, respectively, and progression-free survival rates were 43.6%, 33.0%, 29.0%, and 26.8%, respectively. Platelet count &lt; 100 × 109/L (P &lt; 0.001), sodium level &lt; 135 mmol/L (P = 0.002), maximum tumor diameter ≥ 10 cm (P = 0.001), and treatment other than resection (transarterial therapy vs. resection: P &lt; 0.001, others vs. resection: P = 0.002) were significantly associated with poorer overall survival; sodium &lt; 135 mmol/L (P = 0.015), maximum tumor diameter ≥ 10 cm (P &lt; 0.001), and treatment other than resection (transarterial therapy vs. resection: P &lt; 0.001, others vs. resection: P = 0.001) were independently associated with poorer progression-free survival.ConclusionResection as an initial treatment should be considered when possible, even in patients with single large HCC with good performance status and mild cirrhosis. Caution should be exercised in patients with low platelet level (&lt; 100 × 109/L), low serum sodium level (&lt; 135 mmol/L), and maximum tumor diameter ≥ 10 cm.

How much tumor volume is responsible for development of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas?

Purpose Meningiomas are the most common primary intracranial neoplasms. Their volume and location are important factors related to the appearance of clinical symptoms. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas. Methods We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution. Results The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: as asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p < 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p < 0.001), maximum tumor diameter (p < 0.001), and tumor volume (p < 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p < 0.001), and tumor volume (p < 0.001). Receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]). Conclusion We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.

Changes in hepatocellular carcinoma aggressiveness characteristics with an increase in tumor diameter

Background: Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation. Aims: To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases. Methods: A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality. Results: A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels ( P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges. Conclusions: The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.