术前BRAF V600E检测对甲状腺乳头状癌病理结局的预测价值  

The predictive value of preoperative BRAF V600E detection on pathological outcome of thyroid papillary cancer

作　　者：王敏[1] 张威浩 刘俊[1] 杨烨[3] 师晓琴 WANG Min;ZHANG Weihao;LIU Jun;YANG Ye;SHI Xiaoqin(Department of General Surgery,Shanghai First People’s Hospital,Shanghai 200080,China;Department of Surgery,Shanghai United Family Hospital,Shanghai 200336,China;Department of Obstetrics and Gynecology,Shanghai First People’s Hospital,Shanghai 200080,China;Department of Pathology,Shanghai First People’s Hospital,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院普外科,上海200080 [2]上海和睦家医院外科,上海200336 [3]上海市第一人民医院妇产科,上海200080 [4]上海市第一人民医院病理科,上海200080

出　　处：《肿瘤》2022年第12期806-812,共7页Tumor

基　　金：上海市松江区科学技术委员会科技攻关项目(20SJKJGG304);上海市第一人民医院特色研究项目(CTCCR-2021C19)

摘　　要：目的:探讨术前细针吸取细胞学检查(fine-needle aspiration cytology,FNAC)联合BRAFV600E突变检测对于甲状腺乳头状癌(papillary thyroid carcinoma,PTC)病理结局的预测价值。方法:选择术前在超声引导下进行FNAC和BRAF V600E检测,并且经术后病理学检查证实为PTC且完成BRAF V600E检测的159例患者。分为突变型和野生型,比较2组之间临床病理特征的差异,并且进行单因素和多因素分析。结果:术前BRAF V600E检测突变型与野生型患者仅有明显甲状腺外侵犯(gross extrathyroidal extension,gETE)存在显著差异(P=0.041),而性别、年龄、肿瘤最大径、肿瘤多灶性和中央区淋巴结转移的差异均无统计学意义(P>0.05)。ETE的单因素和多因素分析结果显示,肿瘤最大径﹥1cm(P=0.003)、男性(P=0.026)和术前FNAC BRAFV600E突变(P=0.042)是PTC gETE的独立危险因素;肿瘤最大径>1 cm(P=0.010)和男性(P=0.032)是PTC ETE的独立危险因素。结论:术前FNAC BRAF V600E检测对于PTC gETE具有一定的预测价值,可以联合其他因素在术前进行综合评估,以指导手术方式的选择。Objective:To explore the predictive value of preoperative fine-needle aspiration cytology(FNAC)combined with BRAF V600E mutation detection for the pathological outcome of papillary thyroid carcinoma(PTC).Methods:A total of 159 patients who underwent FNAC and BRAF V600E detection under the guidance of ultrasound before operation and were confirmed as PTC by postoperative pathological examination and completed BRAF V600E detection were selected.They were divided into mutant type and wild type,and the differences of clinicopathologic characteristics between the two groups were compared,and univariable and multivariable analyses were performed.Results:There was only significant difference in gross extrathyroid extension(gETE)between the BRAF V600E mutant and BRAF V600E wild-type patients before operation(P=0.041),and there were no significant differences in gender,age,tumor maximum diameter,tumor multifocal and lymph node metastasis in the neck central area(P>0.05).The results of univariate and multivariate analyses of ETE showed that the maximum tumor diameter>1 cm(P=0.003),male(P=0.026)and preoperative FNAC BRAF V600E mutation(P=0.042)were independent risk factors for gETE in PTC;the maximum diameter of tumor>1 cm(P=0.010)and male(P=0.032)were independent risk factors for ETE in PTC.Conclusion:Preoperative FNAC BRAF V600E detection has certain predictive value for gETE in PTC,which can be combined with other factors for comprehensive evaluation before operation to guide the selection of surgical procedures.

关 键 词：甲状腺乳头状癌 细针吸取细胞学检查 BRAF V600E 甲状腺外侵犯 

分 类 号：R736.1[医药卫生—肿瘤]