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Papillary thyroid carcinomas with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension
- Source :
- Thyroid : official journal of the American Thyroid Association. 22(6)
- Publication Year :
- 2012
-
Abstract
- Papillary thyroid carcinoma (PTC) patients presenting with cervical lymph nodes (LN) metastases (M) have a variable outcome. The objective of this study is to assess the value of meticulous histopathologic examination and genotyping in stratifying these patients into clinically relevant prognostic subgroups.This was a retrospective clinical and histopathological review of PTC patients with lymph node metastases at presentation identified between 1980 and 2002 in a single institution. Primary tumors from patients who later recurred were matched to a group of patients who did not recur and subjected to mass spectrometry genotyping encompassing the most significant oncogenes in thyroid carcinomas.There were 246 patients who satisfied the inclusion criteria. The median follow-up was 10.8 years. The presence of3 metastatic nodes was an independent predictor of decreased recurrence free survival (p=0.03). In patients45 years, none of 45 with 1-2 metastatic LN recurred, including 26 patients followed for a median of 13 years without radioactive iodine (RAI) therapy. BRAF mutations were found in 28 (78%) of 36 genotyped tumors. Combined positivity for BRAF and extra-nodal extension was much stronger in predicting disease specific survival (DSS) (p=0.004) than the single analysis of BRAF (p=0.12) or extra-nodal extension (p=0.02).(i) The number of metastatic LN is an independent predictor of recurrence in all age groups and identifies a subset of young patients with excellent prognosis who may not benefit from RAI therapy. (ii) Combined positivity for BRAF and extra-nodal extension has additive prognostic value in predicting DSS. (iii) Classification systems that assign the same magnitude of risk for recurrence or death to all patients with N1 disease should be revisited.
- Subjects :
- Oncology
Male
Proto-Oncogene Proteins B-raf
medicine.medical_specialty
Genotype
Endocrinology, Diabetes and Metabolism
Thyroid carcinoma
Iodine Radioisotopes
Endocrinology
Predictive Value of Tests
Internal medicine
medicine
Carcinoma
Humans
Thyroid Neoplasms
Survival rate
Lymph node
Thyroid cancer
Retrospective Studies
business.industry
Retrospective cohort study
Thyroid Cancer and Nodules
Middle Aged
medicine.disease
Prognosis
Carcinoma, Papillary
Survival Rate
medicine.anatomical_structure
Cervical lymph nodes
Thyroid Cancer, Papillary
Predictive value of tests
Lymphatic Metastasis
Mutation
Female
Lymph Nodes
Neoplasm Recurrence, Local
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 15579077
- Volume :
- 22
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Thyroid : official journal of the American Thyroid Association
- Accession number :
- edsair.doi.dedup.....5c69073947bb4aa3eabe417cbe32167e