解放军医学院学报2025，Vol.46Issue(6)：574-582,9.DOI:10.12435/j.issn.2095-5227.25030401
基于基因突变的分子风险分层对甲状腺乳头状癌淋巴结转移的预测价值研究
Predictive value of gene mutations for lymph node metastasis in papillary thyroid carcinoma by using molecular risk group method
张恺 1姚京 2王冰 2万政 2梁志雯 2田文2
作者信息
- 1. 解放军总医院卫勤部,北京 100853
- 2. 解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科,北京 100853
- 折叠
摘要
Abstract
Background Patients with papillary thyroid carcinoma(PTC)generally have a favorable prognosis,but some may develop lymph node metastasis.However,effective methods for predicting lymph node metastasis in PTC are still lacking.Objective To explore the correlation between high-risk molecular subtypes of PTC and lymph node metastasis(LNM)by molecular risk group(MRG).Methods Genetic testing was performed using next-generation sequencing technology(NGS)on postoperative specimens of PTC patients who underwent surgery in the Department of Thyroid(Hernia)Surgery,the First Medical Center of PLA General Hospital from November 2021 to March 2024.Molecular risk stratification was performed for 39 genetic variants,while clinicopathological data of the patients were collected.Logistic regression analysis was conducted to identify factors associated with lymph node metastasis,and the predictive performance of the molecular risk gene(MRG)was evaluated.Results A total of 74 PTC patients were enrolled,including 23 males(31.1%)and 51 females(68.9%).The age ranged from 17 to 69 years,with a median age of(40.16±12.59)years.A total of 39 gene mutations were detected in 74 PTC patients,including 37 SNV/Indel and 2 fusion genes,with a mutation rate of 100%.MRG high-risk classification was found in 38 cases(51.35%)and low-risk classification in 36 cases(48.65%).The relationship between MRG classification and clinicopathological features of papillary thyroid carcinoma showed that the presence of capsular invasion was significantly related to MRG high-risk classification(P=0.035).Multivariate Logistic regression analysis showed that MRG high-risk classification was an independent risk factor for LNM/CLNM/LLNM in PTC patients(OR=3.080/2.545/1.443,P<0.05).Paired four-grid table analysis showed that MRG high-risk classification had a certain evaluation efficacy for lymph node metastasis,central lymph node metastasis and lateral cervical lymph node metastasis,and the AUC was 0.729,0.671 and 0.601,respectively.Statistical inference showed that MRG high-risk classification was significantly associated with lymph node metastasis/central lymph node metastasis(P<0.05),but the dominance(difference test)was also significant(P<0.05),suggesting that it was different from the gold standard.Conclusion MRG high-risk classification is associated with central lymph node metastasis in PTC by molecular risk stratification method.MRG high-risk classification may be a potential indicator for predicting central lymph node metastasis in PTC,which is a new method for preoperative evaluation of central lymph node metastasis in PTC patients.关键词
甲状腺乳头状癌/淋巴结转移/分子风险分层/中央区转移/二代测序Key words
papillary thyroid carcinoma/lymph node metastasis/molecular risk group/central compartment metastasis/next-generation sequencing分类
临床医学引用本文复制引用
张恺,姚京,王冰,万政,梁志雯,田文..基于基因突变的分子风险分层对甲状腺乳头状癌淋巴结转移的预测价值研究[J].解放军医学院学报,2025,46(6):574-582,9.
