Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
Thyroid. 2012 Jun;22(6):575-84. doi: 10.1089/thy.2011.0431. Epub 2012 Apr 3.
Papillary thyroid carcinoma (PTC) patients presenting with cervical lymph nodes (LN) metastases (M) have a variable outcome. The objective of this study is to assess the value of meticulous histopathologic examination and genotyping in stratifying these patients into clinically relevant prognostic subgroups.
This was a retrospective clinical and histopathological review of PTC patients with lymph node metastases at presentation identified between 1980 and 2002 in a single institution. Primary tumors from patients who later recurred were matched to a group of patients who did not recur and subjected to mass spectrometry genotyping encompassing the most significant oncogenes in thyroid carcinomas.
There were 246 patients who satisfied the inclusion criteria. The median follow-up was 10.8 years. The presence of >3 metastatic nodes was an independent predictor of decreased recurrence free survival (p=0.03). In patients <45 years, none of 45 with 1-2 metastatic LN recurred, including 26 patients followed for a median of 13 years without radioactive iodine (RAI) therapy. BRAF mutations were found in 28 (78%) of 36 genotyped tumors. Combined positivity for BRAF and extra-nodal extension was much stronger in predicting disease specific survival (DSS) (p=0.004) than the single analysis of BRAF (p=0.12) or extra-nodal extension (p=0.02).
(i) The number of metastatic LN is an independent predictor of recurrence in all age groups and identifies a subset of young patients with excellent prognosis who may not benefit from RAI therapy. (ii) Combined positivity for BRAF and extra-nodal extension has additive prognostic value in predicting DSS. (iii) Classification systems that assign the same magnitude of risk for recurrence or death to all patients with N1 disease should be revisited.
甲状腺乳头状癌（PTC）患者出现颈部淋巴结（LN）转移（M）的结局存在差异。本研究旨在评估细致的组织病理学检查和基因分型在将这些患者分层为具有临床意义的预后亚组中的价值。
这是一项回顾性临床和组织病理学研究，纳入了 1980 年至 2002 年间在单一机构就诊的伴有淋巴结转移的 PTC 患者。对随后复发的患者的原发肿瘤进行了匹配，并与一组未复发的患者进行了比较，这些患者接受了质谱基因分型，涵盖了甲状腺癌中最重要的癌基因。
符合纳入标准的患者有 246 例。中位随访时间为 10.8 年。转移淋巴结>3 个是无复发生存率降低的独立预测因素（p=0.03）。在<45 岁的患者中，45 例转移淋巴结 1-2 个的患者无一例复发，包括 26 例患者中位随访 13 年未接受放射性碘（RAI）治疗。36 例基因分型肿瘤中有 28 例（78%）发现 BRAF 突变。BRAF 阳性和额外的淋巴结外侵犯联合预测疾病特异性生存（DSS）的能力强于单独分析 BRAF（p=0.12）或额外的淋巴结外侵犯（p=0.02）。
（i）转移淋巴结的数量是所有年龄组复发的独立预测因素，并确定了一组年轻患者具有极好的预后，可能不需要接受 RAI 治疗。（ii）BRAF 阳性和额外的淋巴结外侵犯联合具有预测 DSS 的附加预后价值。（iii）应该重新审视将 N1 疾病的所有患者分配相同复发或死亡风险的分类系统。
