Predictive Factors for Level V Lymph Node Metastases in Papillary Thyroid Carcinoma with BRAFV600E Mutation and Clinicopathological Features

Gui-you Li,1 Hai-long Tan,1 Pei Chen,1 Hui-Yu Hu,1 Mian Liu,1 Deng-jie Ou-yang,1 Rooh-afza Khushbu,1 Deepak Pun,1 Jin-dong Li,1 Zhi-peng Zhang,2 Qiong Yang,1 Peng Huang,1 Shi Chang1 1Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Peng Huang; Shi ChangDepartment of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaTel +86 15273124136; +86 13973192319Email xiangyahp@csu.edu.cn; changshi@csu.edu.cnBackground: Therapeutic lateral neck dissection (LND) is recommended in papillary thyroid carcinoma (PTC) patients with clinically lateral lymph node metastasis (LLNM), whether underwent level V LND remains controversial for lacking of sensitive predicting system. BRAFV600E mutation is associated with aggressive tumor behavior, recurrence, and disease-specific mortality of PTC. However, the relationship between BRAFV600E mutation and level V LNM is unclear.Methods: Univariate and multivariate analyses were retrospectively conducted on the potential predictive factors of 252 PTC patients who underwent initial treatment of neck lymph node dissection from September 2015 to October 2018 in our institute. BRAFV600E mutation and the clinicopathological characteristics of the two groups were compared.Results: LLNM was presented in 208 (82.5%) patients and level II–V LNM was present in 42.8%, 71.2%, 85.1%, 17.8% patients, respectively. BRAFV600E mutation was observed in 188 (74.6%) patients and was significantly associated with patients’ age, lymphocytic thyroiditis, capsule invasion, bilateral central lymph node metastasis (CLNM) and level V LNM in PTC. Univariate analysis revealed that lymphocytic thyroiditis, tumor size, number of CLNM, Level II LNM, Level III LNM, simultaneous Level II+III, simultaneous Level III+IV and simultaneous Level II+III+IV were significantly correlated with Level V LNM. In addition, multivariate analysis revealed that tumor size ≥ 2.5 cm, number of CLNM≥ 3, level II metastases and BRAFV600E mutation were independent Level V LNM predictors (odds ratio 3.910, 3.660, 8.410, 0.439; 95% CI 1.737– 10.135, 1.054– 12.713, 1.233– 57.355, 0.280– 0.827, respectively).Conclusion: In summary, we presented several independent predictive factors for level V LNM in PTC patients. We constructed a risk prediction model consisting of tumor size ≥ 2.5 cm, number of CLNM≥ 3 and level II metastases and BRAFV600E mutation that may guide surgeons to evaluate the nodal status in PTC and perform tailored therapeutic LND.Keywords: papillary thyroid carcinoma, BRAFV600E mutation, level V lymph nodes metastasis, pathological features