BRAF^(V600E)突变与分化型甲状腺癌患者临床病理特征及不同危险度分层预后的相关性分析  

Correlation analysis of BRAF^(V600E)mutation with clinical pathological features and prognosis of differentiated thyroid cancer patients with different risk stratification

作　　者：杨萌 陈平 王心宇 刘保平[1] 王庆祝[1] Yang Meng;Chen Ping;Wang Xinyu;Liu Baoping;Wang Qingzhu(Department of Nuclear Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院核医学科,郑州450052

出　　处：《中华核医学与分子影像杂志》2023年第9期533-537,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨分化型甲状腺癌(DTC)患者B-Raf原癌基因丝/苏氨酸蛋白激酶(BRAF)V600E突变与临床病理特征关系,评估BRAF^(V600E)突变在预测不同危险度分层DTC患者131I治疗效果及随访中的价值。方法回顾性分析2018年1月至2022年6月间在郑州大学第一附属医院行甲状腺全切术后131I治疗的893例DTC患者[男205例、女688例,年龄(42.3±11.9)岁],按照BRAF^(V600E)突变情况分为突变组(729例)和野生型组(164例),根据2015年版美国甲状腺协会(ATA)指南将患者分为低危(39例)、中危(498例)和高危(356例),并将疗效分为疗效满意(ER)和疗效不满意(NER)。采用χ^(2)检验、两独立样本t检验和Mann-WhitneyU检验比较2组间差异。通过logistic回归分析预测不同危险度分层患者治疗效果的影响因素。结果BRAF^(V600E)突变组与野生型组在年龄≥45岁、N分期、单侧或双侧病灶、多灶性、手术方式、淋巴结转移个数及最大径的差异有统计学意义(χ^(2)值:4.45~17.40,t=-4.08,z=-3.08,均P<0.05)。中、高危分层BRAF^(V600E)突变组初始131I治疗前后刺激性甲状腺球蛋白(sTg)值均高于野生型组,而治疗后sTg、甲状腺球蛋白抗体(TgAb)下降值(ΔsTg、ΔTgAb)均低于野生型组,差异均有统计学意义(z值:-9.30~-2.65,均P<0.05);中、高危分层野生型患者中分别有69.0%(60/87)、64.3%(45/70)初始131I治疗后达到ER,高于突变型的57.4%(236/411)、45.8%(131/286),差异具有统计学意义(χ^(2)值:3.96、7.39,P值:0.046、0.007)。BRAF^(V600E)突变是中、高危患者131I治疗效果的独立影响因素[比值比(OR):0.411(95%CI:0.196~0.864)、0.192(95%CI:0.096~0.384),P值:0.019、<0.001]。结论BRAF^(V600E)突变与DTC的高侵袭性相关,且突变组初始131I治疗后sTg、TgAb改善较差。BRAF^(V600E)突变是中、高危DTC患者131I治疗效果的重要影响因素。Objective To explore the relationship between B-Raf proto-oncogene,serine/threonine kinase(BRAF)V600E mutation and clinical pathological features in patients with differentiated thyroid cancer(DTC),and to evaluate the value of BRAF^(V600E)mutation in predicting the efficacy and follow-up of 131I treatment in DTC patients with different risk stratification.Methods From January 2018 to June 2022,893 DTC patients(205 males,688 females,age(42.3±11.9)years)treated with 131I after total thyroidectomy in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Patients were divided into BRAF^(V600E)mutation group(n=729)and wild-type group(n=164).According to the 2015 American Thyroid Association(ATA)guidelines,patients were divided into low-risk(39 cases),medium-risk(498 cases)and high-risk(356 cases),and the curative effect was divided into excellent response(ER)and non-excellent response(NER).Theχ^(2)test,independent-sample t test and Mann-Whitney U test were used to compare differences between the two groups.Logistic regression analysis was performed to predict the influencing factors of treatment effect in DTC patients with different risk stratification.Results The differences in age≥45 years,N stage,unilateral or bilateral DTC,multifocus,mode of operation,number and size of metastatic lymph nodes were statistically significant between BRAF^(V600E)mutation group and wild-type group(χ^(2)values:4.45-17.40,t=-4.08,z=-3.08,all P<0.05).In medium-and high-risk stratification,the stimulated thyroglobulin(sTg)levels before and after 131I treatment were slightly higher in the BRAF^(V600E)mutation group,while significantly sharp decreased of sTg and thyroglobulin antibody(TgAb)in wild-type group(z value:from-9.30 to-2.65,all P<0.05).In medium-and high-risk stratification,69.0%(60/87)and 64.3%(45/70)of BRAF^(V600E)wild-type patients reached ER after 131I treatment,which were higher than those of mutant patients(57.4%(236/411)and 45.8%(131/286);χ^(2)values:3.96,7.39,P values:0.046,0.007).BRAF^(

关 键 词：甲状腺肿瘤 突变 原癌基因蛋白B-raf 预后 

分 类 号：R736.1[医药卫生—肿瘤]