BRAFV600E突变及颈部淋巴结转移与甲状腺乳头状癌甲状腺外侵犯的关系

Relationship between BRAF V600E mutation , cervical lymph node metastases and extrathyroidal extension in papillary thyroid carcinoma

目的探讨BRAFV600E突变状态和颈部淋巴结转移（CLNM）与甲状腺乳头状癌（PTC）患者临床病理特征间的关系。方法回顾性分析2012年1月至2014年12月行甲状腺切除术的262例PTC患者临床病理资料。所有患者均行同侧颈部中央区淋巴结清扫术和BRAFV600E突变的检测。结果BRAFV600E阳性与阴性患者甲状腺外侵犯的发生率分别为30．6％（45／147）及10-4％（12／115），CLNM阳性与阴性患者甲状腺外侵犯的发生率分别为30．8％（37／120）及14．1％（20／142），差异均有统计学意义（均P〈0．005）。logistic回归分析结果显示，单一BRAFV600E阳性或CLNM阳性的患者PTC发生甲状腺外侵犯的风险显著增高（OR=5．02，95％ CI=1．56—16．13，P=0．007；OR=3．94，95％CI=1．07～14．46，P=0．039）。BRAFV600E阳性合并CLNM的PTC患者发生甲状腺外侵犯的风险进一步增高（OR=11．09，95％CI=3．54～34．74，P〈0．001）。结论BRAFV600E突变及CLNM与PTC发生甲状腺外侵犯相关。BRAFV600E阳性伴CLNM的PTC患者发生甲状腺外侵犯的风险进一步增高。

Objective To explore the relationship between BRAF V600E mutation status as well as cervical lymph node metastases（CLNM） and clinical pathological features of papillary thyroid carcinoma （PTC）. Methods The clinicopathologic data of 262 PTC patients who underwent thyroidectomy from January 2012 to December 2014 were retrospectively analyzed. All patients were performed ipsilateral cervical central compartment lymph node dissection and BRAF V600E mutation testing. Results Either BRAF V600E or CLNM positive status was associated with extra thyroidal extension of PTC, as compared with that in corresponding negative patients, respectively [BRAF V600E ： 30.6 % （45/147） vs. 10.4 % （12/115）, P 〈 0.001; CLNM： 30.8 % （37/120） vs. 14.1% （20/142）, P= 0.001]. Logistic regression analysis showed that PTC with BRAF V600E or CLNM was more prone to develop extra thyroidal extension, respectively （BRAF V600E： OR=5.02, 95% CI = 1.56-16.13, P =0.007; CLNM： OR =3.94, 95 % CI = 1.07-14.46, P =0.039）. The combined effect of BRAF V600E and CLNM for PTC was found to be more susceptible to extra thyroidal extension （OR = 11.09, 95 %CI = 3.54-34.74, P 〈 0.001）. Conclusions Both BRAF V600E mutation and CLNM are significantly associated with extra thyroidal extension of PTC. PTC with BRAF V600E and CLNM has increased the risk of extra thyroidal extension.