[Relationship and clinical significance between mutated BRAF with prophylactic central-neck nodal dissection in papillary thyroid carcinoma].

ABSTRACT

OBJECTIVE: To evaluate the molecular diagnosis marker of papillary thyroid carcinoma (PTC), the relationship between lymphatic metastasis of central neck compartment PTC, and the operation indication of prophylactic central neck dissection. METHODS: We conducted a retrospective study, including 275 PTC patients and detected their BRAF mutation rates during 2012 and 2014 and explored the risk factors of the central node lymphatic metastasis by Logistic regression model. RESULTS: Of the 275 PTC patients, 224 (81.5%) were female and 51 (18.5%) were male. BRAF mutational rates were 53.8% (148/275) and lymphatic metastasis 57.8% (159/275). Multivariate analysis showed calcification (OR(adjusted)=1.47, 95%CI 1.10-1.98, P=0.01), tumor diameter (OR(adjusted)=1.48, 95%CI 1.04-2.30, P=0.048) and age (OR(adjusted)=1.48, 95%CI 1.04-2.30, P=0.048) were associated with lymphatic metastasis. In stratified analysis, BRAF mutation (OR(adjusted)=3.19, 95%CI 1.18-9.43, P=0.023) in clear boarder group and BRAF mutation (OR(adjusted)=4.84, 95%CI 1.68-13.84, P=0.003) in calcification group were more likely to have lymphatic metastases. CONCLUSION: Central neck metastasis takes up a high ratio in papillary thyroid cancer patients, BRAF mutation in papillary thyroid carcinoma is a characteristic molecular event. Furthermore, patients with calcification under ultrasound detection, lower age group and longer tumor diameter are more susceptible to suffer central neck metastasis. Especially for stratified analysis, non-calcified BRAF mutation or BRAF mutation with clear border under ultrasound detection are more susceptible to suffer central neck metastasis, and radical prophylactic central neck dissection should be carried on for these patients.