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PROGNOSTIC SIGNIFICANCE OF TERT PROMOTER AND BRAF MUTATIONS IN TIR-4 AND TIR-5 THYROID CYTOLOGY
- Publication Year :
- 2019
-
Abstract
- ObjectiveFollicular-derived thyroid cancers generally have a good prognosis, but in a minority of cases, they have an aggressive behavior and develop distant metastases, with an increase in the associated mortality. None of the prognostic markers currently available prior to surgery can identify such cases.MethodsTERTpromoter andBRAFgene mutations were examined in a series of 436 consecutive TIR-4 and TIR-5 nodes referred for surgery. Follow-up (median: 59 months, range: 7–293 months) was available for 384/423 patients with malignant nodes.ResultsTERTpromoter andBRAFmutations were detected in 20/436 (4.6%) and 257/434 thyroid nodules (59.2%), respectively. At the end of the follow-up, 318/384 patients (82.8%) had an excellent outcome, 48/384 (12.5%) had indeterminate response or biochemical persistence, 18/384 (4.7%) had a structural persistence or died from thyroid cancer.TERTpromoter mutations correlated with older age (P P = 0.0002), oxyntic and aggressive PTC variants (P = 0.01), higher tumor stages (P P TERTpromoter mutation was not an independent predictor of disease outcome.TERTpromoter mutation- (OR: 40.58; 95% CI: 3.06–539.04), and N1b lymph node metastases (OR: 40.16, 95% CI: 3.48–463.04) were independent predictors of distant metastases.BRAFmutation did not predict the outcome, and it correlated with a lower incidence of distant metastases (P = 0.0201).ConclusionsTERTpromoter mutation proved an independent predictor of distant metastases, giving clinicians the chance to identify many of the patients who warranted more aggressive initial treatment and closer follow-up.
- Subjects :
- Male
Oncology
Endocrinology, Diabetes and Metabolism
Carcinoma, Papillary, Follicular
Gene mutation
medicine.disease_cause
DYNAMIC RISK STRATIFICATION
CLINICOPATHOLOGICAL FEATURES
DISTANT METASTASIS
V600E MUTATION
CANCER
PAPILLARY
ASSOCIATION
CARCINOMA
PREVALENCE
MANAGEMENT
Endocrinology
Cytology
Adenocarcinoma, Follicular
Medicine
Neoplasm Metastasis
Promoter Regions, Genetic
Telomerase
Lymph node
Thyroid cancer
Mutation
Thyroid
Age Factors
General Medicine
Middle Aged
Prognosis
Tumor Burden
medicine.anatomical_structure
Thyroid Cancer, Papillary
Lymphatic Metastasis
Female
Adult
Proto-Oncogene Proteins B-raf
Thyroid nodules
medicine.medical_specialty
Text mining
Internal medicine
Humans
Neoplasm Invasiveness
Thyroid Neoplasms
Neoplasm Staging
business.industry
medicine.disease
Multivariate Analysis
Lymph Nodes
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....e9dc351bf79946853596c2d651df9929