野生型RET与RET/PTC融合基因检测对甲状腺乳头状癌中央区淋巴结清扫的指导意义  

The significance of detection of wild-type RET and RET/PTC fusion gene for lymph node dissection in the central region of papillary thyroid carcinoma

作　　者：樊丽超 郭瑾瑛 陈鑫 Lichao Fan;Jinying Guo;Xin Chen(Department of Thyroid and Breast Surgery,Fengfeng General Hospital,North China Medical and Health Group,Sanmenxia Henan Province 056200,China)

机构地区：[1]华北医疗健康集团峰峰总医院甲状腺乳腺外科,河南三门峡056200

出　　处：《中华普外科手术学杂志（电子版）》2023年第6期631-635,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨野生型RET(WT-RET)与RET/甲状腺乳头状癌(PTC)融合基因检测对PTC中央区淋巴结清扫的指导意义。方法选取2020年10月至2022年10月行中央区淋巴结清扫的300例PTC患者,术后行野生型RET与RET/PTC融合基因检测,按照中央区淋巴结是否转移分为两组,转移组(155例)和无转移组(145例)。应用SPSS 25.0软件对数据进行统计学分析,通过多因素Logistic回归分析影响PTC患者中央区淋巴结转移的独立危险因素,并构建列线图预测模型。P<0.05为差异有统计学意义。结果两组患者的年龄、病灶直径、病灶数量、肿瘤分期、浸润被膜、野生型RET、RET/PTC融合基因、淋巴结肿大、病变腺叶差异性有统计学意义(P<0.05);多因素Logistic回归分析提示影响PTC患者中央区淋巴结转移的独立危险因素有年龄<45岁、病灶直径≥1.0 cm、多发病灶数、T_(3-4)期、有浸润被膜、野生型RET阳性、RET/PTC融合基因阳性、淋巴结肿大、病变腺叶单侧(P<0.05);列线图模型并验证,结果提示训练集和验证集的C-index分别为0.850、0.826,两集的曲线下面积分别为0.802、0.789,当阈值概率在0.01~0.91之间的决策曲线,净获益值比较高。结论野生型RET与RET/PTC融合基因是预测PTC患者发生中央区淋巴结转移的独立危险因素,能指导临床医生对这类患者谨慎选择中央区淋巴结清扫范围,基于临床特征及基因检测特征构建列线图风险预测模型,具有较高的预测性能,有助于指导临床决策。Objective The guiding significance of wild-type RET and RET/PTC fusion gene detection in central lymph node dissection of papillary thyroid carcinomaMethods A total of 300 PTC patients who underwent lymph node dissection in central region from October 2020 to October 2022 were selected, and wild-type RET and RET/PTC fusion gene detection were performed after surgery. They were divided into two groups according to whether central region lymph nodes were metastatic (155 cases) and no metastasis (145 cases). SPSS 25.0 software was used for statistical analysis of the data, and the independent risk factors affecting central lymph node metastasis in PTC patients were analyzed by multi-factor Logistic regression, and a nomogram prediction model was constructed. P<0.05 was considered statistically significant.Results There were significant differences in age, lesion diameter, number of lesions, tumor stage, infiltrating membrane, wild type RET, RET/PTC fusion gene, lymph node enlargement and pathological gland and lobe between the two groups (P<0.05). Multivariate Logistic regression analysis suggested that the independent risk factors for central lymph node metastasis in PTC patients were age < 45 years and lesion diameter ≥1.0 cm, number of multiple lesions, stage T_(3-4), infiltrating membrane, wild type RET positive, RET/PTC fusion gene positive, lymph node enlargement, unilateral lobe lesions (P<0.05);The results show that the C-index of the training set and the verification set are 0.850 and 0.826, respectively, and the area under the curve of the two sets is 0.802 and 0.789, respectively. When the threshold probability is between 0.01 and 0.91, the net benefit value is higher.Conclusion Wild-type RET and RET/PTC fusion genes are independent risk factors for predicting central lymph node metastasis in PTC patients, which can guide clinicians to carefully select the scope of central lymph node dissection for such patients, and construct a nomoimagedata risk prediction model based on clinical characteristics and g

关 键 词：甲状腺肿瘤 癌 乳头状 癌基因蛋白质类 融合 中央区淋巴结 基因检测 

分 类 号：R736.1[医药卫生—肿瘤]