BRAF^(T1799A)在甲状腺乳头状癌患者外周血中的表达及其临床意义

Expression and clinical significance of BRAF^(T1799A) in peripheral blood of patients with papillary thyroid carcinoma

目的检测甲状腺乳头状癌(PTC)患者外周血中BRAF^(T1799A)表达情况,并探究其临床意义。方法选取2015年1月至2018年1月期间本院收治的PTC患者297例为研究对象,PCR检测血清BRAF^(T1799A)RNA水平,分析BRAF^(T1799A)RNA水平与PTC患者临床病理特征及复发转移之间的关系。结果 (1)297例PTC患者中,183例表现为BRAF^(T1799A)基因突变,突变率为61.62%;组织BRAF^(T1799A)+PTC患者血清中均检测到BRAF^(T1799A)RNA。(2)血清BRAF^(T1799A)水平与PTC患者性别、年龄、肿瘤大小无明显相关性(P>0.05),与肿瘤临床分期、肿瘤多发灶、包膜外侵犯、淋巴结转移、骨转移、规范化治疗6个月Tg值有关(P<0.05)。(3)治疗前BRAF^(T1799A)水平对PTC患者不良预后预测的ROC曲线下面积(AUC)为0.894,敏感性为69.87%,特异性为94.61%。(5)血清BRAF^(T1799A)水平高的PTC患者2年复发率显著高于血清BRAF^(T1799A)低水平者(32.10%vs 1.96%,P<0.05)。结论血清BRAF^(T1799A)RNA水平与PTC患者临床分期、肿瘤多发灶、包膜外侵犯、淋巴结转移、骨转移及规范化治疗6个月Tg值有关,可作为评估患者不良预后的生物指标。

Objective To detect the expression of BRAF^（T1799A） in peripheral blood of patients with papillary thyroid carcinoma（PTC）,and explore its clinical significance. Methods A total of 297 patients with PTC were enrolled in this hospital from January 2015 to January 2018. The serum BRAF^（T1799A） level was detected by PCR. The relationships between BRAF^（T1799A） level and clinicopathological features,recurrence and metastasis of PTC patients were analyzed. Results（1） Among 297 PTC patients,183 cases showed a BRAF^（T1799A） mutation and the mutation rate was 61.62%. BRAF^（T1799A） RNA was detected in the serum of tissue BRAF^（T1799A） ＋patients.（2）There was no significant correlation between serum BRAF^（T1799A） level and gender,age and tumor size of PTC patients（P〈0.05）. However,it was related to tumor clinical stage,tumor multiple foci,extracapsular invasion,lymph node metastasis,bone metastasis,and Tg value of standardized treatment for 6 months（P〈0.05）.（3）The area under the ROC curve（AUC）predicted by the BRAF^（T1799A） level for poor prognosis of PTC patients was 0.894,the sensitivity was 69.87%,and the specificity was 94.61%.（4）The twoyear recurrence rate of PTC patients with high level of serum BRAF^（T1799A） was significantly higher than those with low level of serum BRAF^（T1799A） （32.10% vs 1.96%,P〈0.05）. Conclusion The level of serum BRAF^（T1799A） RNA was associated with clinical stage,tumor multiple foci,outer capsule invasion,lymph node metastasis,bone metastasis and Tg value of standardized treatment for 6 months. And it can be used as a biological indicator to evaluate the poor prognosis of PTC patients.