BRAF V600E突变与甲状腺乳头状癌临床病理特征的相关性

目的:探讨BRAF V600E基因突变对甲状腺乳头状癌（PTC）临床病理特征的影响。方法:收集经甲状腺切除术且病理证实为PTC患者的临床资料，分析BRAF V600E基因突变与PTC临床病理特征、甲状腺功能的关系。结果:PTC患者882例，发生BRAF V600E基因突变者722例（81.86%），单因素分析显示，突变组癌灶多发、双侧、包膜外侵犯比例、复发危险度分层中/高危及TNM分期Ⅲ/Ⅳ期明显高于未突变组，差异均有统计学意义（均P＜0.05）；而淋巴结转移率、转移数目和直径均无统计学差异；突变组TPOAb、TGAb、TSH水平低于未突变组，差异均有统计学意义（均P＜0.05），FT4、FT3水平无统计学差异（均P＞0.05）。分别行多因素Logistic回归分析显示:BRAF V600E基因突变与癌灶多发、包膜外侵犯显著相关（OR值分别为1.722、1.436，均P＜0.05）；原发癌灶直径>1 cm、BRAF基因突变、TGAb异常升高与PTC患者包膜外侵犯呈独立正相关（OR值分别为2.862、1.619、1.532，均P＜0.05）。结论:BRAF V600E基因突变的PTC易发多灶和包膜外侵犯，提示可能有不良预后；癌灶直径>1 cm、BRAF V600E基因突变及TGAb异常升高是PTC包膜外侵犯的独立危险因素。

The correlation between BRAF V600E mutation and the clinicopathological features of thyroid papillary carcinoma

Objective:To investigate the effect of BRAF V600E gene mutation on the clinicopathological features of thyroid papillary carcinoma (PTC).Methods:The clinical data of patients who underwent thyroidectomy and were pathologically confirmed as PTC were collected to analyze the relationship between BRAF V600E gene mutation and the clinicopathological characteristics and thyroid function of PTC patients.Results:Among 882 PTC patients,722 (81.86%) had BRAF V600E gene mutation.Univariate analysis showed that multiple cancer foci,bilateral foci,proportion of extracapsular extension invasion,middle/high recurrence risk stratification,and TNM Ⅲ/Ⅳ stage were significantly higher in the mutant group than those in the non-mutant group (all P＜0.05).There was no significant difference in lymph node metastasis rate,number and diameter.Besides,TPOAb,TGAb and TSH levels in the mutant group were lower than those in the non-mutant group,with statistically significant differences (all P＜0.05),while FT4 and FT3 levels showed no statistically significant differences (all P＞0.05).Multivariate Logistic regression demonstrated that BRAF V600E gene mutation was significantly correlated with multiple cancer lesions and extracapsular invasion (OR values were 1.722 and 1.436,all P＜0.05).The primary tumor diameter of >1 cm,BRAF gene mutation,and abnormal increase of TGAb were independently positively correlated with the extracapsular invasion of PTC patients (OR values were 2.862,1.619 and 1.532,all P＜0.05).Conclusion:PTC with BRAF V600E gene mutation was prone to occur multiple foci and capsular invasion,which suggested that they may have poor prognosis.The tumor diameter >1 cm,BRAF V600E gene mutation and abnormal increase of TgAb were independent risk factors for PTC invasion.