BRAFV600E 突变与甲状腺乳头状癌淋巴结转移的关系及对放射性碘治疗后s-Tg的影响

The association between BRAFV600E mutation and lymph node metastasis of papillary thyroid cancer and its effect on stimulated thyroglobulin radioactive iodine

    摘要
  • 摘要:
    目的 探讨BRAFV600E突变与甲状腺乳头状癌（PTC）淋巴结转移的关系，以及其对PTC患者放射性碘（RAI）治疗后刺激性甲状腺球蛋白（s-Tg）水平的影响。
    方法 回顾性分析2013年1月至2018年12月于郑州大学附属肿瘤医院行甲状腺全切或近全切手术且病理证实为PTC并行BRAF基因检测的2647例患者男性599例、女性2048例，年龄8~84（45.00±11.70）岁的临床病理资料。根据BRAFV600E基因是否突变，将患者分为突变组（2230例）和野生组（417例），分析2组间年龄、性别、肿瘤长径和淋巴结转移的差异。选取接受过2次RAI治疗的PTC患者86例男性28例、女性58例，年龄13~77（42.72±15.69）岁），同样分为突变组（57例）和野生组（29例），分析2组间在行RAI治疗前后的s-Tg水平差异。采用χ2检验、两独立样本t检验和Mann-Whiney U秩和检验比较2组患者的临床资料；采用配对t检验评价s-Tg水平与BRAFV600E突变之间的关系。
    结果 2647例PTC患者的BRAFV600E突变率为84.2%（2230/2647）。突变组的年龄和淋巴结转移的患者比例均高于野生组（45.29±11.51）岁对(43.43±12.53)岁，t=5.28，P=0.022；48.39%对41.97%，χ2=5.81，P=0.016。在接受2次RAI治疗的86例PTC患者中，第2次RAI治疗前，突变组的s-Tg水平明显高于野生组（61.16±90.95） ng/mL对（18.56±37.77） ng/mL，Z=−2.41，P=0.003；与突变组相比，野生组患者第1次和第2次RAI治疗前的s-Tg水平差值明显下降（−1.61±37.18） ng/mL对（−24.00±30.00） ng/mL，t=−2.81，P=0.006。
    结论 BRAFV600E突变的PTC患者出现淋巴结转移的风险较高，初始RAI治疗后生化指标s-Tg改善较差。

     

    Abstract:
    Objective To evaluate the association between BRAFV600E mutation and the lymph node metastasis (LNM) of papillary thyroid cancer (PTC). The effect of BRAFV600E mutation on stimulated thyroglobulin (s-Tg) after radioactive iodine (RAI) remnant ablation treatment was also evaluated.
    Methods The clinicopathological data of 2647 PTC patients (599 males; 2048 females; age range: 8–84 (45.00±11.70) years) who underwent near total or total thyroidectomy at Henan CancerHospital Affiliated to Zhengzhou University, from January 2013 to December 2018 were retrospectivelycollected and analyzed. The BRAFV600E status of the primary tumor was then identified. The patients were subsequently divided into the BRAFV600E mutation group (2230 cases) and the BRAFV600E wild group (417 cases), and differences in age, gender, tumor size, and lymph node metastasis between these two groups were analyzed. A total of 86 PTC patients (males 28; females 58; age range: 13–77 (42.72±15.69) years) who had received two RAI treatments were filtered from the groups and evaluated further in terms of differences in s-Tg level. The basic data of the two groups were compared via the chi-squared, two independent samples Student's t, and Mann-Whitney U rank-sum tests. Paired t test was used to evaluate the relationship between s-Tg and BRAFV600E mutation.
    Results The overall prevalence of BRAFV600E mutation in this study was 84.2% (2230/2647). The mean age and proportion of LNM were significantly higher in the mutation group than in the non-mutation group (45.29±11.51) years vs. (43.43±12.53) years, t=5.28, P=0.022; 48.39% vs. 41.97%, χ2=5.81, P=0.016. Among the 86 PTC patients who received RAI two RAI treatments, s-Tg levels were slightly higher in the mutation group (61.16±90.95) ng/mL vs. (18.56±37.77) ng/mL, Z=−2.41, P=0.003, while significantly sharp decreased of s-Tg in wild group (−1.61±37.18) ng/mL vs. (−24.00±30.00) ng/mL, t=−2.81, P=0.006 undergoing the first RAI remnant ablation. High s-Tg levels were present in the mutation group after the initial treatment.
    Conclusion PTC patients with the BRAFV600E mutation are at higher risk of developing LNM in PTC and show poor improvement in biochemical indicators after initial treatment.

     

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