Poyrazoğlu Şükran, Bundak Rüveyde, Baş Firdevs, Yeğen Gülçin, Şanlı Yasemin, Darendeliler Feyza
İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey.
J Clin Res Pediatr Endocrinol. 2017 Sep 1;9(3):185-193. doi: 10.4274/jcrpe.3873. Epub 2017 Jan 12.
Papillary thyroid cancer (PTC) may behave differently in prepubertal children as compared to pubertal children and adults. BRAF gene activating mutations may associate with PTC by creating aberrant activation. We aimed to evaluate the clinicopathological characteristics of PTC patients with emphasis on the pubertal status and also to investigate the association of BRAF mutation with disease characteristics.
The medical records of 75 patients with PTC were reviewed retrospectively. BRAF mutation status was available only in the medical records of 56 patients.
Mean age at diagnosis was 12.4±3.8 years. There was no difference in sex, initial signs, tumor histopathology, and pathological evidence of tumor aggressiveness between prepubertal and pubertal children. Although not statistically significant, lateral neck nodal metastasis and lung metastasis at diagnosis were more prevalent in prepubertal children. After excluding patients with microcarcinoma, prepubertal children were found to require lateral neck dissection and further doses of radioactive iodine more frequently than pubertal patients. Recurrence was also more frequent in prepubertal children (p=0.016). Frequency of BRAF mutation was similar in prepubertal and pubertal patients. BRAF mutation was found in 14/56 (25%) patients and was high in the classic variant PTC (p=0.004). Multicentricity was high in BRAF mutation (p=0.01). There was no relation between BRAF mutation and lymph node and pulmonary metastasis at diagnosis, or between BRAF mutation and pathological evidence of tumor aggressiveness.
PTC is more disseminated in prepubertal children. BRAF mutation does not correlate with a more extensive or aggressive disease. BRAF mutation is not the cause of the differences in the biological behavior of PTC in prepubertal and pubertal children.
与青春期儿童及成人相比，甲状腺乳头状癌（PTC）在青春期前儿童中的表现可能有所不同。BRAF基因激活突变可能通过产生异常激活而与PTC相关。我们旨在评估PTC患者的临床病理特征，重点关注青春期状态，并研究BRAF突变与疾病特征之间的关联。
回顾性分析75例PTC患者的病历。仅56例患者的病历中有BRAF突变状态信息。
诊断时的平均年龄为12.4±3.8岁。青春期前儿童与青春期儿童在性别、初始体征、肿瘤组织病理学以及肿瘤侵袭性的病理证据方面无差异。虽然无统计学意义，但青春期前儿童诊断时颈部侧方淋巴结转移和肺转移更为常见。排除微癌患者后，发现青春期前儿童比青春期患者更频繁地需要进行颈部侧方清扫和进一步的放射性碘治疗。青春期前儿童的复发也更频繁（p = 0.016）。BRAF突变在青春期前和青春期患者中的频率相似。14/56（25%）的患者检测到BRAF突变，在经典型PTC中该突变率较高（p = 0.004）。BRAF突变患者的多中心性较高（p = 0.01）。BRAF突变与诊断时的淋巴结和肺转移之间，或BRAF突变与肿瘤侵袭性的病理证据之间均无关联。
PTC在青春期前儿童中更易播散。BRAF突变与疾病范围更广或侵袭性更强无关。BRAF突变不是青春期前和青春期儿童PTC生物学行为差异的原因。
