LOP/C和BRAFV600E基因突变与甲状腺微小乳头状癌颈部淋巴结转移的关联性研究  

Association of LOP/C and BRAFV600E gene mutations with cervical lymph node metastasis in papillary thyroid microcarcinoma

作　　者：王崇杰 翟振国[1] 张亮 邵禹铭 张晶 朱坤兵[1] WANG Chong-jie;ZHAI Zhen-guo;ZHANG Liang;SHAO Yu-ming;ZHANG Jing;ZHU Kun-bing(Department of Breast and Thyroid Surgery,Shandong Maternal and Child Health Hospital,Jinan 250101,China;Affiliated Hospital of Shandong Academy of Medical Sciences,Jinan 250031,China;Department of Pathology,Third Provincial Hospital of Shandong Province,Jinan 250031,China)

机构地区：[1]山东省妇幼保健院乳腺甲状腺外科,山东济南250101 [2]山东省医学科学院附属医院乳腺甲状腺外科,山东济南250031 [3]山东省医学科学院附属医院病理科,山东济南250031 [4]山东省立第三医院病理科,山东济南250031

出　　处：《中华肿瘤防治杂志》2022年第13期990-995,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省医药卫生科技发展计划(2017WSB03002)。

摘　　要：目的 探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的高风险因素。方法 回顾性分析山东省医学科学院附属医院2008-01-01-2018-12-31接受全甲状腺切除加预防性中央区和颈侧区淋巴结清除术的72例PTMC患者的临床病理资料,镜检病灶中的细胞极性/黏附性丧失(LOP/C),使用RT-PCR检测BRAFV600E突变,分析PTMC颈部淋巴结转移的高风险因素。结果 63.9%(46/72)的PTMC患者存在颈部淋巴结转移,40.3%(29/72)的患者同时具有中央区淋巴结转移(CLNM)及颈侧区淋巴结转移(LLNM),11.1%(8/72)的患者只存在CLNM,6.9%(5/72)的患者只存在LLNM。单因素分析结果显示,LOP/C和BRAFV600E突变与PTMC患者发生CLNM(χ^(2)=12.043,P<0.001;χ^(2)=4.538,P=0.032)和LLNM(χ^(2)=15.360,P<0.001;χ^(2)=7.525,P=0.006)具有关联性。年龄<55岁的PTMC患者更容易发生LLNM,χ^(2)=5.394,P=0.020。LLNM更多见于男性PTMC患者,χ^(2)=4.922,P=0.027。多因素分析结果显示,男性(OR=3.708,95%CI:1.234~11.140,P=0.020)、LOP/C(OR=5.569,95%CI:2.383~13.012,P<0.001)和BRAFV600E突变(OR=3.302,95%CI:1.132~9.635,P=0.029)是影响PTMC发生CLNM的高危因素;LOP/C(OR=3.203,95%CI:1.262~8.130,P=0.014)和BRAFV600E突变(OR=3.939,95%CI:1.162~13.349,P=0.028)是影响PTMC发生LLNM的高危因素。同时,CLNM(OR=7.640,95%CI:2.894~20.169,P<0.001)也是发生LLNM的高风险因素。结论 男性、年龄<55岁、存在LOP/C、BRAFV600E突变和CLNM是PTMC患者发生LLNM的高危因素。应警惕此类人群发生LLNM的风险。Objective To investigate the high risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma(PTMC).Methods The clinicopathological data of 72 patients with PTMC who received total thyroidectomy plus prophylactic central and lateral cervical lymph node dissection in the Affiliated Hospital of Shandong Academy of Medical Sciences from 2008-01-01-2018-12-31 were retrospectively analyzed.Loss of cell polarity/adhesion(LOP/C) in lesions was examined by microscopy, and BRAFV600 E mutation was detected using RT-PCR to analyze high-risk factors for cervical lymph node metastasis in PTMC.Results 63.9%(46/72) of PTMC patients had cervical lymph node metastasis, 40.3%(29/72) had both central lymph node metastasis(CLNM) and lateral cervical lymph node metastasis(LLNM),11.1%(8/72) had CLNM only, and 6.9%(5/72) had LLNM only.Univariate analysis showed that LOP/C and BRAFV600Emutations were associated with CLNM (χ^(2)=12.043,P<0.001;χ^(2)=4.538,P=0.032)and LLNM (χ^(2)=15.360,P<0.001;χ^(2)=7.525,P=0.006).PTMC patients aged <55years were more likely to develop LLNM,χ^(2)=5.394,P=0.020.LLNM was more common in male PTMC patients,χ^(2)=4.922,P=0.027.Multivariate analysis showed that male(OR=3.708,95%CI:1.234-11.140,P=0.020),LOP/C(OR=5.569,95%CI:2.383-13.012,P<0.001)and BRAFV600Emutation(OR=3.302,95%CI:1.132-9.635,P=0.029)were high risk factors for CLNM in PTMC.The LOP/C(OR=3.203,95%CI:1.262-8.130,P=0.014)and BRAFV600E mutation(OR=3.939,95%CI:1.162-13.349,P=0.028)were high-risk factors for LLNM in PTMC.Meanwhile,CLNM(OR=7.640,95%CI:2.894-20.169,P<0.001)was also a high risk factor for LLNM.Conclusion Male gender,age<55years,presence of LOP/C,BRAFV600 Emutation and CLNM are high risk factors for LLNM in patients with PTMC.The risk of developing LLNM in this population should be vigilant.

关 键 词：甲状腺微小乳头状癌 细胞极性/黏附性丧失 BRAFV600E 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]