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.
背景：在所有癌症类型中，肿瘤直径可能无法准确反映肿瘤负荷。本研究旨在探讨甲状腺乳头状癌（PTC）中肿瘤体积（TV）与侵袭性特征及预后的关系。方法：研究纳入诊断为单灶性PTC的患者。以最大肿瘤直径作为主要肿瘤直径，并根据病理学测量的三个维度，采用椭球体公式计算肿瘤体积。比较主要肿瘤直径与肿瘤体积在侵袭性肿瘤特征及预后方面的差异。结果：共分析118例患者数据。主要肿瘤直径与淋巴结转移（LNM）、甲状腺外侵犯（ETE）及血管侵犯均无显著相关性（各项p>0.05）。在肿瘤直径>2 cm的患者中，肿瘤体积与淋巴结转移呈负相关（p=0.015）。肿瘤体积每增加一个单位，无淋巴结转移的可能性增加1.629倍（95% CI: 1.099–2.415）。当肿瘤体积≤5.26 cm³时，预测淋巴结转移存在的敏感性和特异性分别为88.9%和75.8%。在该组患者中，当肿瘤体积≤9.49 cm³时，预测甲状腺外侵犯发生的敏感性和特异性分别为100.0%和45.7%。肿瘤直径与肿瘤体积在五年无病生存率方面无显著差异。结论：与文献中其他癌症类型的研究结果相反，本研究发现甲状腺乳头状癌的肿瘤体积与淋巴结转移存在显著负相关关系。需要进一步开展大规模研究以确定肿瘤体积是否可作为PTC的预后预测因子。
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