BRAFV600E基因突变与甲状腺微小乳头状癌淋巴结转移的相关性研究

目的:探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）发生淋巴结转移是否与BRAFV600E基因突变相关。方法:回顾性分析行手术治疗的55例甲状腺微小乳头状癌有淋巴结转移（A组）和70例甲状腺微小乳头状癌无淋巴结转移（B组）的患者，用免疫组化对其肿瘤组织及转移性的淋巴结进行BRAFV600E基因突变蛋白检测并通过统计学分析甲状腺微小乳头状癌淋巴结转移与BRAFV600E基因突变的相关性。结果:A组总的BRAFV600E基因突变率（69.1%）、右侧PTMC（78.3%）、双侧PTMC的突变率(83.3%)要分别高于B组(37.1%、26.7%、42.9%)（P值均＜0.05），但强阳性率（23.6%）和左侧PTMC的突变率（50.0%）与B组（11.4%、46.2%）相比无统计学差异（P值均＞0.05）。A组组内淋巴结转移灶BRAFV600E基因突变率无论PTMC在左侧（72.2%）、右侧（92.0%）或双侧（91.7%）的阳性率和强阳性率（30.9%）上与原发灶（50.0%、78.3%、83.3%、23.6%）均无差异（P＞0.05），但总的突变率，前者（85.5%）要高于后者（69.1%）（P＜0.05）。结论:BRAFV600E突变是导致PTMC早期发生淋巴结转移的重要因素之一，术前或术后通过各种方法测得的BRAFV600E突变阳性预示着淋巴结转移的高风险。

The study of correlation between papillary thyroid microcarcinoma lymph node metastasis and BRAFV600E mutation

Objective:To study the correlation between papillary thyroid microcarcinoma (PTMC) lymph node metastasis and BRAFV600E mutation.Methods:Retrospectively analyze the BRAFV600E mutant protein of 55 patients of PTMC with lymph node metastasis (group A) and 70 patients of PTMC without lymph node metastasis (group B) through IHC.Then the correlation between PTMC and BRAFV600E mutant was analysed.Results:The gene mutation rates of total BRAFV600E（69.1%）,right PTMC （78.3%） and bilateral PTMC (83.3%) of group A were higher than that of group B (37.1%，26.7%，42.9%)（P＜0.05）.However,the mutation rate of strongly positive （23.6%） and mutation rate of left PTMC （50.0%） were not statistically significant compared with group B (11.4%,46.2%)（P＞0.05）.In group A,the BRAFV600E mutation rates of left (72.2%),right (92.0%) and bilateral thyroid (91.7%) and strongly positive rate (30.9%) in lymph node metastasis lesion had no difference compared with primary lesion (50.0%,78.3%,83.3%,23.6%) （P＞0.05）.But,the total mutation rate of the former (85.5%) was higher than the later (69.1%) （P＜0.05）.Conclusion:BRAFV600E mutation is one of the important factors that lead to early lymph node metastasis in PTMC,and the mutation of BRAFV600E detected by various methods before or after surgery indicates a high risk of lymph node metastasis.