The Correlation Between BRAF^V600EMutation And Clinical Invasiveness And¹³¹Ⅰ Efficacy In Differentiated Thyroid Cancer

ObjectiveTo analyze the correlation between BRAFV600E mutation and aggressiveness of differentiated thyroid carcinoma(DTC)and its clinical significance,to explore the correlation between BRAFV600E mutation and 131Ⅰ efflcacy in non-distant metastatic papillary thyroid carcinoma(PTC),and to preliminarily analyze the difference of BRAFV600E mutation expression between primary tumors(PT)and lymph node-metastasized tumors(LNT)MethodsA retrospective analysis was made of 2012 patients with differentiated thyroid carcinoma admitted to our department from January 2014 to November 2017.All patients underwent surgical resection and pathological confirmation of DTC.This study is divided into three chapters.Chapter 1 analyses the relationship between BRAFV600E mutation and clinical invasiveness of DTC.Chapter 2 explores the correlation between BRAFV600E mutation and 131Ⅰ efficacy in high-risk PTC patients with non-distant metastasis.Chapter 3 analyses the difference of BRAFV600E mutation expression between primary tumors and lymph node-metastasized tumors.According to the inclusion and exclusion criteria of each chapter,it was grouped and analyzed by SPSS20.0 statistical softwareResultsIn the first section,1510 DTC patients were enrolled.There were 1169 cases with BRAFV600E mutation positive and 341 cases with BRAFV600E mutation negative.The mutation rate was 77.4%.Univariate analysis showed BRAFV60 E mutation associations with age,Pathological type,distant metastasis,tumor diameter,involvement of glandular lobes,extrathyroid infiltration,vascular invasion,distant metastasis,thyroid node,lymph node maximum diameter,maximum diameter of lymph node cancer and recurrence risk.Multivariate logistic regression analysis showed that BRAFV60 E mutation was positively and independently correlated with older age,bilateral glandular lobes involved,and negatively correlated with distant metastasis and vascular invasion,while BRAFV600E mutation was significantly correlated with gross extrathyroidal extension and multifocality in advanced clinical stages and high-risk subgroups.(P<0.05).In the second section,1220 PTC patients were enrolled.The median follow-up time was 2.67 years(0.67-4.67 years).The total 13 Ⅰ dose was 7.7±3.6GBq(1,3-23.3GBq).According to the 2015 edition of ATA guidelines,713 cases(58.4%)were excellent response,54 cases(4.4%)were indeterminate response,290 cases(23.8%)were Biochemical incomplete response,and 163 cases(13.4%)were Structural incomplete response.Confirmation of lymph node lesion diameter,Tg value before initial iodine treatment,number of affected lymph nodes,family history,envelope invasion and BRAFV600E mutation are independent risk factors for the efficacy of patients.Among them,with the BRAF 600E mutation,the risk of biochemical incomplete response and indeterminate response is higher.In the third section,271 DTC patients were included,the status of their BRAFV600E mutation:PT(+)/LNT(+)212 patients(78.2%),PT(-)/LNT(-)42 patients(15.5%),PT(+)/LNT(-)11 patients(4.1%)and PT(-)/LNT(+)6 patients(2.2%).The Kappa test coefficient was 0.793,which proved that the BRAFV600E mutation of the two groups was basically the same,and there was no significant difference.ConalusionBRAFV600E mutation mainly occurs in classical papillary thyroid cancer,and is associated with some invasive factors of thyroid cancer,especially involving Bilaterality and older age of diagnosis.The correlation between BRAFV600E mutation and invasiveness is more evident in high-risk recurrence group and stage Ⅲ/Ⅳclinical staging subgroup.For patients with low-risk PTC who are not distantlymetastatic,131Ⅰ is an effective adjuvant therapy,but there are also many risk factors that affect afficacy.There are some differences in BRAFV600E mutations between primary trmors and lymph node-metastasized tumors,but there is no statistical difference between them.