BRAF^(V600E)突变与乳头状甲状腺癌中央区淋巴结转移的关系

Association of BRAF^(V600E) mutation with central compartment lymph node metastasis in papillary thyroid carcinoma

目的:探讨乳头状甲状腺癌(PTC)中BRAF基因突变的临床意义。方法:选择2年间符合条件的PTC手术患者126例,提取患者石蜡切片中的DNA样本,用荧光PCR法检测BRAF基因V600E(BRAFV600E)的突变情况,分析BRAFV600E突变与PTC患者临床病理因素及中央区淋巴结转移的关系。结果:126例PTC患者BRAFV600E突变的发生率为69.0%(87/126)。单因素与多因素分析显示,BRAFV600E突变与淋巴结转移有关(P<0.05);中央区淋巴结转移与年龄、肿瘤大小、肿瘤分期和BRAFV600E突变有关(均P<0.05)。进一步分析显示,肿瘤直径≤10 mm时,BRAFV600E突变与中央区淋巴结转移无关(P>0.05),肿瘤直径>10 mm时,BRAFV600E突变患者的中央区淋巴结转移率高于突变阴性患者(P<0.05)。结论:BRAFV600E突变是PTC中央区淋巴结转移风险的独立预测因子;对于术前检测BRAFV600E突变阳性患者,肿瘤直径越大越应该重视中央区淋巴结清扫。

Objective：To investigate the clinical significance of the BRAF gene mutation in papillary thyroid carcinoma（PTC）.Methods：One-hundred and twenty-two eligible PTC patients undergoing surgical treatment within the past 2years were selected.DNA samples of the patients were extracted from paraffin sections and the V600 E mutation of the BRAF gene（BRAFv600E） was detected by fluorescent PCR.The relations of BRAFv600E mutation with clinicopathologic factors and central compartment lymph node metastasis were analyzed.Results：The incidence of BRAFv600E mutation was 69.0%（87/126） in the 126 PTC patients.Univariate and multivariate analysis showed that BRAFv600E mutation was significantly related to lymph node metastasis（P〈0.05）,and central compartment lymph node metastasis was significantly associated with age,tumor size,tumor stage and BRAFv600E mutation（all P〈0.05）.Further analysis demonstrated that BRAFv600E mutation had no significant relation with central compartment lymph node metastasis in patients whose tumor size was equal to or less than10 mm（P〉0.05）,while among patients with tumor size larger than 10 mm,the incidence of central compartment lymph node metastasis was significantly higher in positive BRAF mutation cases than that in negative BRAFv600E mutation ones（P〈0.05）.Conclusion：BRAFv600E mutation is an independent predictor associated with aggressive tumor behavior and is an independent predictive factor for central compartment neck dissection.In those cases with positive BRAFv600Emutation,the larger the size of the tumor,the more important it is to perform central compartment neck dissection.