BRAF基因突变型的甲状腺乳头状癌中央区淋巴结转移的预测模型  

A predictive model for the central lymph node metastasis in papillary thyroid carcinoma with BRAF gene mutation

作　　者：蔡业丰 倪纯珏 陈恩东[1] 郑华敏[3] 张筱骅[1] 李权[1] 

机构地区：[1]温州医科大学附属第一医院肿瘤外科,浙江温州325000 [2]温州医科大学附属第一医院麻醉科,浙江温州325000 [3]温州医科大学附属第一医院超声影像科,浙江温州325000

出　　处：《中国现代医生》2016年第3期1-4,12,F0003,共6页China Modern Doctor

基　　金：国家863高技术研究发展计划(2012AA02A210);浙江省温州市科技计划项目(Y20140136)

摘　　要：目的在BRAF基因突变型的甲状腺乳头状癌中,构建预测中央区淋巴结转移的预测模型。方法回顾性分析179例BRAF基因突变型的PTC。根据临床病理资料,通过单因素、多因素统计学分析中央区淋巴结转移的独立预测因子,使用标准化回归系数,根据独立预测因子来构建"10分制"的预测模型,ROC曲线来评估预测模型的预测价值。结果男性(P<0.001),年龄<45岁(P=0.042),肿瘤大小≤9 mm(P=0.002),下极(P=0.045),B超示淋巴结转移(P=0.012)是BRAF突变型的PTC中央区淋巴结转移的独立预测因子。对评分模型进行验证,确定3.25分为预测模型的最佳截值点,其预测的灵敏度为73.5%,特异度为67.9%。结论在BRAF基因突变型的PTC中,本研究的中央区淋巴结转移的预测模型具有一定预测价值,对指导PTC的手术具有重要的临床意义。当结节的评分>3.25分时,可以考虑予以中央区淋巴结清扫,而当评分<3.25分时,可以考虑不予以中央区淋巴结清扫。Objective To establish a predictive model for the central lymph node metastasis（CLNM） in papillary thyroid carcinoma（PTC） with BRAF gene mutation. Methods Retrospectively analyzed of 179 patients of papillary thyroid carcinoma with BRAF gene mutation were enrolled. Univariate and multivariate analyses were performed to find the independent predictors for CLNM based on clinicopathological and US features. Used the standardized regression coefficient, a 10-point score system was constructed in line with the independent predictors. Then, ROC curves determined the cutoff value and evaluated its predictive value in predicting CLNM. Results Man（P〈0.001）, age45 years（P=0.042）,tumor size≤9 mm（P=0.002）, the lower pole（P=0.045）, display of metastasis lymph node（P=0.012） were the independent predictors for CLNM in PTC with BRAF gene mutation. Verifying the scoring system, a cutoff value of 3.25 point was found to be best prediction for CLNM and its sensitivity and specificity were 73.5% and 67.9%. Conclusion The predictive model is helpful for surgeons to decide the most suitable surgical strategy for PTC with BRAF gene mutation.When the score 〉3.25, the central lymph node dissection should be considered. While the score 〈3.25, the central lymph node dissection（CLND） ought to be cautious.

关 键 词：甲状腺乳头状癌 中央区淋巴结转移 预测模型 BRAF 淋巴结清扫 

分 类 号：R736.1[医药卫生—肿瘤]