Meta-analysis Of The Effect Of Combined BRAF And Telomerase Reverse Transcriptase Promoter Mutations On Clinicopathological Features And Prognosis Of Papillary Thyroid Cancer

Objective: The purpose of this study is to investigate the effect of combined BRAF and TERT promoter mutations on clinicopathological features and prognosis of papillary thyroid cancer.Methods: A search strategy was derived using synonyms of the following search keywords: “combined mutation of BRAF and TERT promoter”,“papillary thyroid carcinoma” and their synonyms from medical database.Collect all relevant literature about fertility-preserving treatment in the effect of combined BRAF and TERT promoter mutations on clinicopathological features and prognosis of papillary thyroid cancer from January 2014 to December 2019.Languages were restricted to Chinese and English.Literatures were selected,according to strict inclusion and exclusion criteria.Revman 5.3 were employed for the calculations and statistical tests.Results: 16 articles including 6342 PTC patients were enrolled in this study.The results showed: compared with BRAF V600 E mutation or TERT promoter mutation alone,BRAF V600 E and TERT promoter combined mutation have a stronger correlation with invasive clinical manifestations and poor prognosis of papillary thyroid carcinoma.Including advanced TNM stage(vs.Only BRAF+ : OR=4.57,95%CI [3.43;6.09];vs.Only TERT+ :OR=5.25,95%CI [3.29;8.38]),extrathyroid invasion(vs.Only BRAF+ :OR=3.00,95%CI [2.28;3.94];vs.Only TERT+:OR=5.77,95%CI [3.68;9.06]),lymph node metastasis(vs.Only BRAF+ : OR=1.78,95%CI [1.40;2.27];vs.Only TERT+:OR=2.15,95%CI [1.46;3.17]),distant metastasis(vs.Only BRAF+:OR=15.26,95%CI [6.35;36.69];vs.Only TERT+:OR=1.32,95%CI [0.60;2.91]),risk of recurrence(vs.Only BRAF+:OR=5.67,95%CI [3.58;8.97];vs.Only TERT+:OR=4.19,95%CI [1.82;9.65]),PTC related mortality(vs.Only BRAF+ : OR=13.46,95%CI [6.53;27.75];vs.Only TERT+ :OR=3.55,95%CI [1.33;9.49]).Conclusions: Coexistent BRAF V600 E and TERT promoter mutations have a synergistic effect on the clinicopathological features and prognosis in PTC,including more prone to extrathyroid invasion,lymph node metastasis and distant metastasis,and higher risk of recurrence and mortality.Combination of BRAF V600 E and TERT promoter mutations detection may be helpful to evaluate risk stratification and prognosis of PTC.