BRAF^(V600E)基因突变与甲状腺乳头状癌腺外侵犯的相关性

Association between BRAF^(V600E) gene mutation and extrathyroidal extension in papillary thyroid carcinoma

目的探讨BRAF^(V600E)基因突变与甲状腺乳头状癌(PTC)患者发生甲状腺腺外侵犯的关系。方法回顾性收集武汉大学人民医院2017–2019年期间所有PTC手术患者的临床病理资料,从中筛选出检测过BRAF^(V600E)基因突变的患者并分析PTC患者BRAF^(V600E)基因突变与甲状腺腺外侵犯的关系。结果依据纳入和排除标准共纳入273例患者,其中BRAF^(V600E)无突变者50例、BRAF^(V600E)突变者223例,有甲状腺腺外侵犯者194例、无79例。单因素分析发现,相较于无甲状腺腺外侵犯者,BRAF^(V600E)突变发生率在有甲状腺腺外侵犯患者中更高(86.1%比70.9%,P=0.003);同时相较于BRAF^(V600E)无突变者,甲状腺腺外侵犯发生率在BRAF^(V600E)突变患者中更高(74.9%比54.0%,P=0.003);另外,肿瘤直径>1 cm、双侧癌、多癌灶者甲状腺腺外侵犯发生率分别高于肿瘤直径≤1 cm(86.7%比61.3%,P<0.001)、单侧癌(89.6%比63.8%,P<0.001)、单癌灶(85.7%比60.9%,P<0.001)者;甲状腺腺外侵犯发生率随淋巴结分期增高呈增高趋势(P=0.003)。多因素logistic回归分析发现,直径>1 cm[OR=3.606,95%CI(1.758,7.396),P<0.001]、多癌灶[OR=2.524,95%CI(1.154,5.519),P=0.020]和BRAF^(V600E)突变[OR=3.022,95%CI(1.443,6.326),P=0.003]是PTC患者发生甲状腺腺外侵犯的危险因素。结论本研究初步结果提示,伴BRAF^(V600E)突变的PTC患者更易发生甲状腺腺外侵犯。

Objective To investigate association between BRAF^(V600E) gene mutation and extrathyroidal extension(ETE)among patients with papillary thyroid carcinoma(PTC).Methods A retrospective study was conducted to collect all PTC surgical patients in the Renmin Hospital of Wuhan University from 2017 to 2019.The patients tested for BRAF^(V600E) gene mutation were selected,and the association between BRAF^(V600E) gene mutation and ETE were analyzed.Results The BRAF^(V600E) gene mutation test was performed only in 273 cases,223 and 50 of whom were BRAF^(V600E) gene with and without mutation,respectively;194 and 79 of whom had ETE and no ETE,respectively.Univariate analysis showed that the incidence rate with BRAF^(V600E) gene mutation was higher in the patients with ETE as compared with the patients without ETE(86.1%vs 70.9%,P=0.003)and the incidence rate of ETE was higher in the patients with BRAF^(V600E) gene mutaton than in the patients without BRAF^(V600E) gene mutaton(74.9%vs 54.0%,P=0.003).In addition,the incidence rates of ETE in the patients with tumor diameter>1 cm,bilaterality,and multifocality were higher than those in the patients with tumor diameter≤1 cm(86.7%vs 61.3%,P<0.001),unilaterality(89.6%vs 63.8%,P<0.001),and single lesion(85.7%vs 60.9%,P<0.001),respectively.The incidence rate of ETE was increased with the increase of lymph node stage(P=0.003).Multivariate logistic regression analysis showed tumor size>1 cm[OR=3.606,95%CI(1.758,7.396),P<0.001],multifocality[OR=2.524,95%CI(1.154,5.519),P=0.020],with BRAF^(V600E) gene mutaton[OR=3.022,95%CI(1.443,6.326),P=0.003]were the risk factors for ETE.Conclusion The preliminary results of this study suggest that PTC patients with BRAF^(V600E) gene mutaton are more likely to gross ETE.