Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Front Endocrinol (Lausanne). 2022 Mar 11;13:808298. doi: 10.3389/fendo.2022.808298. eCollection 2022.
Papillary thyroid microcarcinomas (PTMCs) have been attributed to the recent increased incidence of thyroid cancer. Although indolent, a subset of PTMC could potentially develop distant metastasis (DM). This study aimed to evaluate the clinico-pathological features and molecular characteristics of PTMC and identify the risk factors for DM in PTMC patients from Middle Eastern ethnicity.
We retrospectively analyzed 210 patients with histologically confirmed PTMC. Clinico-pathological associations for DM, mutation and mutation were analyzed successfully in 184 patients. Multivariate analysis was performed using Cox proportional hazards model and logistic regression analysis.
Among the PTMC patients included in this cohort, DM was noted in 6.0% (11/184), whereas tumor relapse occurred in 29/184 (15.8%). Of the 11 cases with DM, lung metastasis occurred in 8 cases, bone metastasis in 2 cases and brain metastasis in 1 case. Presence of extrathyroidal extension and male sex were significantly associated with DM. Molecular analysis showed mutations to be the most frequent, being detected in 45.7% (84/184). promoter mutations were detected in 16 (8.7%) cases and were significantly associated with DM and shorter metastasis-free survival in multivariate analysis.
Our study indicates a surprisingly high frequency of promoter mutation in Saudi patients with PTMC. Identifying promoter mutations as an independent predictor of DM in patients with microcarcinoma could explain the inherent aggressive nature of PTMC from Middle Eastern ethnicity and magnify its role in patient risk stratification, which might help in improving therapeutic strategy for these patients.
甲状腺微小乳头状癌（PTMC）的发病率最近有所增加，被认为与甲状腺癌有关。虽然其生物学行为惰性，但仍有一部分 PTMC 可能发生远处转移（DM）。本研究旨在评估中东人群中 PTMC 的临床病理特征和分子特征，并确定 PTMC 患者发生 DM 的危险因素。
我们回顾性分析了 210 例经组织学证实的 PTMC 患者。成功分析了 184 例患者的 DM、 突变和 突变的临床病理相关性。使用 Cox 比例风险模型和逻辑回归分析进行多变量分析。
在本队列的 PTMC 患者中，DM 发生率为 6.0%（11/184），肿瘤复发率为 29/184（15.8%）。在 11 例 DM 患者中，肺转移 8 例，骨转移 2 例，脑转移 1 例。甲状腺外侵犯和男性与 DM 显著相关。分子分析显示 突变最为常见，占 45.7%（84/184）。检测到 16 例（8.7%） 启动子突变，在多变量分析中与 DM 和无复发生存时间缩短显著相关。
我们的研究表明，沙特阿拉伯 PTMC 患者中 启动子突变的频率惊人地高。将 启动子突变鉴定为微癌患者 DM 的独立预测因子，可解释中东人群中 PTMC 固有的侵袭性，并突出其在患者风险分层中的作用，这可能有助于改善这些患者的治疗策略。
