The BRAF V600E mutation analysis and risk stratification in papillary thyroid carcinoma.

Objective: Although the prognostic role of BRAF ^V600E mutation in papillary thyroid carcinoma (PTC) is controversial, the American Thyroid Association (ATA) includes the mutational status in their risk stratification system. To evaluate the impact of the BRAF ^V600E mutation status on PTC risk stratification.
Methods: PTC patients attending a university-based hospital who had the analysis of the BRAF ^V600E mutation were included. Persistent disease was defined as the presence of biochemical or structural disease. The performance of the ATA risk stratification system on predicting persistent disease with or without the BRAF ^V600E mutation status information was evaluated.
Results: Of the 134 patients evaluated, 44 (32.8%) carried BRAF ^V600E mutation. The median tumor size was 1.7 cm (P25-75 1.0-3.0), 64 (47.8%) patients had lymph node, and 11 (8.2%) distant metastases. According to the ATA risk stratification system, patients were classified as low, intermediate, and high risk in 55 (41%), 59 (44%), and 20 (14%) patients, respectively. The data on BRAF ^V600E mutation reclassified 12 (8.9%) patients from low to intermediate risk. After a median follow-up of 8.5 years, the prevalence of persistent disease was similar in patients with and without BRAF ^V600E mutation (P = 0.42). Multivariate analysis failed to demonstrate an association between the BRAF ^V600E mutation and persistent disease status (RR 0.96; 95%CI 0.47-1.94). Notably, none of the patients reclassified from low to intermediate risk showed persistent disease on follow-up.
Conclusion: Inclusion of BRAF ^V600E mutational status has a limited impact on risk stratification and does not add to the prediction of outcomes in PTC patients.