BRAF^V600E突变与不同复发风险的甲状腺乳头状癌患者术后转移的关系

Relationship between BRAFV600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma with different recurrence risk stratification

目的探讨V-raf鼠类肉瘤滤过性病毒致癌基因同源体B1(BRAF)V600E突变与不同复发风险的甲状腺乳头状癌(PTC)患者发生术后转移的关系。方法回顾性分析2014年3月至2017年9月于聊城市人民医院核医学科行131I治疗且已行BRAFV600E突变检测的134例PTC术后患者,其中男45例、女89例,年龄16~72岁。将患者手术时的复发风险分为低危、中危及高危3层;术后随访时根据有无转移将每层患者分为未转移组、颈部淋巴结转移组及肺转移组。比较各组患者发生BRAFV600E突变情况,采用χ2检验分析数据。结果134例PTC患者的BRAFV600E突变率为55.22%(74/134)。低危患者(46例)各转移组突变率差异无统计学意义(χ2=2.39,P>0.05)。中危患者(47例)颈部淋巴结转移组基因突变率(16/19)明显高于肺转移组(3/8)和未转移组(25.00%,5/20;χ2值:5.89和13.75,均P<0.05),但后2组基因突变率差异无统计学意义(χ2=0.44,P>0.05)。高危患者(41例)颈部淋巴结转移组基因突变率(85.00%,17/20)高于肺转移组(5/13)和未转移组(1/8;χ2值:7.68和13.08,均P<0.01),但后2组基因突变率差异亦无统计学意义(χ2=1.64,P>0.05)。结论BRAFV600E突变与PTC术后中危、高危患者颈部淋巴结转移密切相关,但不会明显增加低危患者颈部淋巴结转移及各危险层患者肺转移的发生概率。

Objective To investigate the relationship between V-raf murine sarcoma viral oncogene homologue B1(BRAF)V600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma(PTC)with different recurrence risk stratification.Methods From March 2014 to September 2017,134 PTC patients(45 males,89 females;age:16-72 years)who underwent 131I treatment in the Department of Nuclear Medicine of Liaocheng People′s Hospital and had undergone BRAFV600E mutation detection were retrospectively analyzed.The recurrence risk during surgery was divided into 3 levels:low-,medium-and high-risk.Each recurrence risk group was divided into 3 subgroups according to the postoperative follow-up results:non-metastasis group,cervical lymph node metastasis group and pulmonary metastasis group.BRAFV600E mutation rates in different groups were compared(χ2 test).Results The BRAFV600E mutation rate was 55.22%(74/134)in 134 PTC patients.The mutation rates were not significantly different in the 3 metastasis subgroups for low-risk patients(n=46;χ2=2.39,P>0.05).In medium-risk patients(n=47),the mutation rate in neck lymph node metastasis group(16/19)was higher than that in pulmonary metastasis group(3/8)and non-metastasis group(25.00%,5/20;χ2 values:5.89 and 13.75,both P<0.05),while there was no difference between pulmonary metastasis group and non-metastasis group(χ2=0.44,P>0.05).In high risk patients(n=41),the mutation rate in neck lymph node metastasis group(85.00%,17/20)was higher than that in the pulmonary metastasis group(5/13)and non-metastasis group(1/8;χ2 values:7.68 and 13.08,both P<0.01),while there was no difference between pulmonary metastasis group and non-metastasis group(χ2=1.64,P>0.05).Conclusion The BRAFV600E mutation is closely related to neck lymph node metastasis after operation in middle-and high-risk patients with PTC,but it does not significantly increase the probabilities of neck lymph node metastasis in low-risk patients and pulmonary metastasis in low-,medium-and high-risk patients.