Kim Seo Ki, Woo Jung-Woo, Lee Jun Ho, Park Inhye, Choe Jun-Ho, Kim Jung-Han, Kim Jee Soo
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Surgery. 2015 Dec;158(6):1500-11. doi: 10.1016/j.surg.2015.05.016. Epub 2015 Jun 26.
The extent of surgery for papillary thyroid carcinoma (PTC) is associated strongly with disease persistence, recurrence, and mortality. It is difficult, however, to determine the optimal extent for surgery. The BRAF mutation is well known for its diagnostic and prognostic value in PTC. Among the variants of PTC, the clinical importance of the BRAF mutation has been associated particularly with conventional PTC. The goal of this study was to clarify the role of the BRAF mutation as a determinant for the operative extent in conventional PTC.
Histopathology and BRAF mutation status of 3,019 patients with conventional PTC were analyzed. With regard to the extent of surgery in PTC, focus was given to the factors of tumor bilaterality, central lymph node metastasis (CLNM), and lateral lymph node metastasis. In addition, the prognostic impact of BRAF mutation on loco-regional recurrence was investigated.
The BRAF mutation was found to be an independent indicator of tumor bilaterality (odds ratio [OR] 1.484, P = .010); however, it was not an independent indicator of CLNM (OR 1.167, P = .254) or lateral lymph node metastasis (OR 0.647, P = .384). Moreover, it was not an independent indicator of CLNM in either the therapeutic or prophylactic central neck dissection. Finally, BRAF mutation positivity did not increase the risk of loco-regional recurrence (adjusted hazard ratio = 0.829, P = .523).
The BRAF mutation is a possible indicator for determining the extent of thyroidectomy required but not for the extent of lymph node dissection and prognosis in patients with conventional PTC.
甲状腺乳头状癌（PTC）的手术范围与疾病持续存在、复发和死亡率密切相关。然而，确定最佳手术范围很困难。BRAF突变在PTC中的诊断和预后价值已广为人知。在PTC的各种变体中，BRAF突变的临床重要性尤其与经典型PTC相关。本研究的目的是阐明BRAF突变作为经典型PTC手术范围决定因素的作用。
分析了3019例经典型PTC患者的组织病理学和BRAF突变状态。关于PTC的手术范围，重点关注肿瘤双侧性、中央淋巴结转移（CLNM）和侧方淋巴结转移等因素。此外，还研究了BRAF突变对局部区域复发的预后影响。
发现BRAF突变是肿瘤双侧性的独立指标（优势比[OR]1.484，P = 0.010）；然而，它不是CLNM（OR 1.167，P = 0.254）或侧方淋巴结转移（OR 0.647，P = 0.384）的独立指标。此外，在治疗性或预防性中央颈清扫术中，它也不是CLNM的独立指标。最后，BRAF突变阳性并未增加局部区域复发的风险（调整后风险比 = 0.829，P = 0.523）。
BRAF突变可能是确定经典型PTC患者所需甲状腺切除范围的指标，但不是确定淋巴结清扫范围和预后的指标。
