Department of Radiotherapy, Istituto Oncologico Veneto-IRCCS, Padua, Italy.
Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
Sci Rep. 2021 Mar 31;11(1):7303. doi: 10.1038/s41598-021-86611-6.
Only a minority of cases of differentiated thyroid carcinoma (DTC) have a poor clinical outcome. Clinical outcomes and molecular aspects were assessed in: 144 DTC ≤ 40 mm without distant metastases (group 1); 50 DTC > 40 mm without distant metastases (group 2); and 46 DTC with distant metastases (group 3). Group 3 had a worse outcome than the other two groups: during the follow-up, patients more frequently had persistent disease, died, or underwent further treatment. The outcomes did not differ between groups 1 and 2. Group 3 had a higher prevalence of TERT promoter mutations than group 2 (32.6% vs 14%). Group 1 had a higher frequency of BRAF mutations than groups 2 or 3 (61.1% vs 16.0% and 26.1%, respectively), while RAS mutations were more common in group 2 than in groups 1 and 3 (16.0% vs 2.1% and 6.5%, respectively). Groups 1 and 2 shared the same outcome, but were genetically distinct. Only lymph node involvement, distant metastases, older age and (among the molecular markers) TERT promoter mutations were independent predictors of a worse outcome. Metastatic DTC had the worst outcome, while the outcome was identical for large and small non-metastatic DTC, although they showed different molecular patterns. TERT promoter mutations emerged as an independent factor pointing to a poor prognosis.
只有少数分化型甲状腺癌（DTC）病例的临床预后较差。在以下患者中评估了临床结局和分子方面：144 例无远处转移的≤40mm DTC（组 1）；50 例无远处转移的>40mm DTC（组 2）；以及 46 例有远处转移的 DTC（组 3）。与其他两组相比，组 3 的结局更差：在随访期间，患者更频繁地出现持续性疾病、死亡或需要进一步治疗。组 1 和组 2 的结局没有差异。组 3 的 TERT 启动子突变发生率高于组 2（32.6%比 14%）。组 1 的 BRAF 突变频率高于组 2 和组 3（61.1%比 16.0%和 26.1%），而 RAS 突变在组 2 中比组 1 和组 3 更常见（16.0%比 2.1%和 6.5%）。组 1 和组 2 具有相同的结局，但基因不同。只有淋巴结受累、远处转移、年龄较大以及（在分子标志物中）TERT 启动子突变是预后不良的独立预测因素。转移性 DTC 的结局最差，而大小不同的非转移性 DTC 的结局相同，尽管它们显示出不同的分子模式。TERT 启动子突变是预后不良的独立因素。
