The correlation between BRAFV600E gene mutations and clinical pathological characteristics of papillary thyroid carcinoma
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摘要:
目的 甲状腺乳头状癌(papillary thyroid carcinoma，PTC)是一种常见的恶性肿瘤，发病率逐年增加，其发病机制和临床特征仍不十分明确，本文拟探讨PTC患者BRAFV600E基因突变检测结果与其临床病理特征的关系，为PTC患者的治疗决策提供依据。 方法 按照严格的纳入标准从蚌埠医科大学第一附属医院甲乳外科2022年1—9月收治的甲状腺乳头状癌患者中收集符合条件的病例资料，采用χ2检验及logistic分析PTC患者BRAFV600E基因突变情况以及与临床病理特征的关系。所有临床数据采用SPSS 26.0统计学软件进行统计学分析。 结果 本研究共纳入108例甲状腺乳头状癌患者，BRAFV600E基因突变率为70.37%(76/108)。单因素分析结果显示，合并桥本甲状腺炎、伴中央区淋巴结转移、包膜侵犯及肿瘤最大径≥0.5 cm与BRAFV600E基因突变有关，差异有统计学意义(P＜0.05)。Logistic分析结果显示，年龄≥55岁、肿瘤最大径≥0.5 cm是BRAFV600E突变的危险因素，而合并桥本氏甲状腺炎是BRAFV600E突变的保护因素。 结论 BRAFV600E检测在甲状腺乳头状癌中具有一定的诊断价值，BRAFV600E检测结果与甲状腺乳头状癌部分临床病理特征存在相关性，BRAFV600E检测结果对临床治疗决策和预后判断具有较好的指导意义。 -
关键词:
- 甲状腺乳头状癌 /
- BRAFV600E基因突变 /
- 临床病理特征
Abstract:Objective Papillary thyroid carcinoma (PTC) is a common malignant tumor. The incidence rate is increasing year by year, and its pathogenesis and clinical characteristics are still not very clear. This article intends to explore the relationship between the BRAFV600E gene mutation detection results and the clinicopathological characteristics of PTC patients, so as to provide a basis for treatment decisions of PTC patients. Methods According to strict inclusion criteria, eligible case data were collected from patients with papillary thyroid carcinoma admitted to the First Affiliated Hospital of Bengbu Medical University from January 2022 to September 2022. Chi-square test and logistic analysis were used to analyze the BRAFV600E gene mutation and its relationship with clinical and pathological characteristics in PTC patients. All clinical data were statistically analyzed using SPSS 26.0 software. Results This study included 108 patients with papillary thyroid carcinoma, with a BRAFV600E gene mutation rate of 70.37% (76/108). The results of univariate analysis showed that the presence of Hashimoto's thyroiditis, central lymph node metastasis, capsule invasion, and maximum diameter of tumor ≥0.5 cm were associated with BRAFV600E gene mutations, and the difference was statistically significant (P < 0.05). The logistic analysis results showed that age ≥55 years and maximum diameter of tumor ≥0.5 cm were risk factors for BRAFV600E mutation, while Hashimoto's thyroiditis was a protective factor for BRAFV600E mutation. Conclusion BRAFV600E detection has a certain diagnostic value in papillary thyroid carcinoma. The results of BRAFV600E detection are correlated with some clinical and pathological features of papillary thyroid carcinoma. The results of BRAFV600E detection have good guiding significance for clinical treatment decision-making and prognosis judgment. -
表 1 108例甲状腺乳头状癌患者的一般临床特征
Table 1. General clinical features of 108 patients with papillary thyroid carcinoma
临床特征 例(%) 性别 男性 22(20.37) 女性 86(79.62) 年龄(岁) ≥55 38(35.19) ＜55 70(64.81) 肿瘤最大径(cm) ≥0.5 75(69.44) ＜0.5 33(30.56) 是否合并桥本氏甲状腺炎 是 21(19.44) 否 87(80.56) 是否有包膜侵犯 是 30(27.78) 否 78(72.22) BRAF基因突变 是 76(70.37) 否 32(29.63) 是否伴中央区淋巴结转移 是(N1期) 36(33.33) 否(N0期) 72(66.67) 肿瘤位置 双侧 21(19.44) 单侧 87(80.56) 甲状腺激素(TPO-Ab、TG-Ab) 正常 89(82.41) 升高 19(17.59) 注：TG-Ab为甲状腺球蛋白抗体，TPO-Ab为甲状腺过氧化物酶抗体。N0期为没有区域淋巴结转移，N1期为有区域淋巴结转移。 
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表 2 PTC患者BRAFV600E突变与其临床病理特征关系[例(%)]
Table 2. Relationship between BRAFV600E mutation and clinical pathological characteristics in PTC patients[cases(%)]
项目 BRAF阳性(n=76) BRAF阴性(n=32) χ2值 P值 性别 0.631 0.427 男性 17(22.37) 5(15.63) 女性 59(77.63) 27(84.37) 年龄(岁) 3.533 0.060 ≥55 31(40.79) 7(21.88) ＜55 45(59.21) 25(78.12) 肿瘤最大径(cm) 21.869 ＜0.001 ≥0.5 63(82.89) 12(37.50) ＜0.5 13(17.11) 20(62.50) 是否合并桥本甲状腺炎 6.472 0.011 是 10(13.16) 11(34.38) 否 66(86.84) 21(65.62) 是否伴中央区淋巴结转移 8.882 0.002 是 32(42.11) 4(12.50) 否 44(57.89) 28(87.50) 是否有包膜侵犯 12.085 0.001 是 29(38.16) 1(3.13) 否 47(61.84) 31(96.87)
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表 3 PTC患者BRAFV600E突变与其临床病理特征的logistic多因素分析
Table 3. Logistic multivariate analysis of BRAFV600E mutation and its clinical pathological characteristics in PTC patients
变量 B SE Waldχ2 P值 OR(95% CI) 性别 -0.775 0.787 0.970 0.325 0.461(0.098~2.154) 年龄 1.268 0.614 4.264 0.039 3.555(1.067~11.851) 合并桥本甲状腺炎 -1.499 0.644 5.417 0.020 0.223(0.063~0.789) 肿瘤最大径 2.168 0.693 9.791 0.002 8.744(2.248~34.005) 淋巴结转移 0.938 0.746 1.580 0.209 2.555(0.592~11.025) 包膜侵犯 2.151 1.118 3.705 0.054 8.595(0.961~76.840) 注：因变量为BRAF基因突变，阴性=0，阳性=1；自变量赋值如下，女性=0，男性=1；年龄≥55岁=1，＜55岁=0；是否合并桥本甲状腺炎，是=1，否=0；肿瘤最大径≥0.5 cm=1，＜0.5 cm=0；是否伴中央区淋巴结转移，是=1，否=0；是否有包膜侵犯，是=1，否=0。
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