Sheba Medical Center, Tel Hashomer, Israel.
Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Am J Otolaryngol. 2022 May-Jun;43(3):103278. doi: 10.1016/j.amjoto.2021.103278. Epub 2021 Nov 11.
Current guidelines consider all cases of papillary thyroid carcinoma (PTC) smaller than 4 cm and without extrathyroidal extension (ETE) and/or lymph node metastases as belonging to the same prognostic group, and therefore the recommendation is for uniform treatment. Xing draws our attention to a small subgroup with Duet Mutations (BRAF E600 and TERT 3636 genes) that are aggressive biologically and should be treated differently. Thus the aim of the present study is to test the validity of this recommendation.
A Markovian Model is used to evaluate the above hypothesis.
A Monte Carlo sensitivity test shows a 5.6 year survival advantage for patients with low-grade PTC, who have the Duet Mutations, and were treated by total thyroidectomy rather than hemithyroidectomy.
We conclude that there is a place for routine molecular tests in low-risk patients with PTC.
目前的指南将所有小于 4 厘米且无甲状腺外侵犯（ETE）和/或淋巴结转移的甲状腺乳头状癌（PTC）病例归为同一预后组，因此建议进行统一治疗。邢提请我们注意一小部分具有 Duet 突变（BRAF E600 和 TERT 3636 基因）的病例，这些病例在生物学上具有侵袭性，应该采用不同的治疗方法。因此，本研究旨在验证这一建议的有效性。
采用马尔可夫模型来评估上述假设。
蒙特卡罗敏感性测试显示，对于患有低级别 PTC 且具有 Duet 突变的患者，如果采用全甲状腺切除术而不是甲状腺叶切除术进行治疗，其 5.6 年生存率有 5.6 年的生存优势。
我们的结论是，对于低危 PTC 患者，常规进行分子检测是有必要的。
