中国普通外科杂志2025，Vol.34Issue(5)：903-912,10.DOI:10.7659/j.issn.1005-6947.250265
不同基因变异型与BRAFV600E突变型甲状腺乳头状癌淋巴结转移特征比较
Comparison of lymph node metastatic characteristics between papillary thyroid carcinomas with different genetic alterations and those with BRAFV600E mutation
摘要
Abstract
Background and Aims:The BRAFV600E mutation is the most common genetic alteration in papillary thyroid carcinoma(PTC)and is widely used to guide surgical extent and risk stratification.However,other genetic variants are increasingly identified in clinical practice,and their association with lymph node metastasis(LNM)remains unclear.Most existing studies have compared BRAFV600E-mutated cases with BRAF wild-type cases without stratifying specific mutation types,potentially affecting the accuracy of risk assessment.This study aimed to compare the lymph node metastatic features between PTC patients with different common genetic alterations and those with the BRAFV600E mutation. Methods:A retrospective analysis was conducted on 4 795 PTC patients who underwent surgery and genetic testing at Fudan University Shanghai Cancer Center from January 2019 to January 2025.Patients with a single genetic alteration were included and grouped accordingly.Propensity score matching(PSM)was used to control for confounding factors including age,sex,and T stage.The number of metastatic lymph nodes and N stage were compared between each mutation group and the BRAFV600E group. Results:After PSM,patients in the CCDC6-RET and NCOA4-RET fusion groups had significantly higher numbers of metastatic lymph nodes and N1b stage rates compared to the BRAFV600E group(all P<0.05).No significant differences were observed between the ETV6-NTRK3 fusion or RAS mutation groups and the BRAFV600E group in terms of lymph node metastasis or N stage(all P>0.05). Conclusion:PTC patients harboring CCDC6-RET or NCOA4-RET fusions exhibit a significantly higher lymph node metastatic burden than those with the BRAFV600E mutation,suggesting more aggressive behavior.In contrast,ETV6-NTRK3 and RAS-mutated PTCs show similar metastatic profiles to BRAFV600E-mutated cases.Preoperative genetic profiling may help identify patients at high risk of metastasis and guide individualized lymph node dissection strategies.关键词
甲状腺肿瘤/癌,乳头状/淋巴转移/基因检测/倾向性评分Key words
Thyroid neoplasms/Carcinoma,Papillary/Lymphatic Metastasis/Genetic Testing/Propensity Score分类
医药卫生引用本文复制引用
官青,刘婉琳,莫淼,王宇..不同基因变异型与BRAFV600E突变型甲状腺乳头状癌淋巴结转移特征比较[J].中国普通外科杂志,2025,34(5):903-912,10.基金项目
科学技术部四大慢病重大专项基金资助项目(2024ZD0525600) （2024ZD0525600）
国家自然科学基金资助项目(82473361) （82473361）
上海市科委重点领域创新计划基金资助项目(22Y21900100) （22Y21900100）
上海市抗癌协会翱翔计划基金资助项目(SACA-AX202404). （SACA-AX202404）
