Correlation between conventional ultrasound features and BRAFV600E gene mutation and central lymph node metastasis in thyroid papillary carcinoma
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摘要: 目的 探讨甲状腺乳头状癌(PTC)中央区淋巴结转移(CLNM)与原发灶常规超声特征及BRAFV600E基因突变的相关性。方法 收集2019年10月—2021年6月经锦州医科大学附属第一医院手术病理确定为PTC并行中央区淋巴结清扫术的300例患者，根据中央区淋巴结是否发生转移分为转移组与非转移组，通过对两组患者原发病灶的常规超声特征及BRAFV600E基因检测结果分析确定其相关性。结果 300例PTC患者中，120例(40%)发生CLNM。单因素分析结果显示：性别、最大径线、病灶数、边界、形态、纵横比、靠近被膜、钙化及BRAFV600E基因突变的组间差异有统计学意义(P＜0.05)；Logistic多因素回归分析结果显示：性别、最大径线、纵横比、靠近被膜、微钙化及BRAFV600E为PTC患者CLNM的危险因素(P＜0.05)。ROC曲线显示：当最大径为8.5 mm时，约登指数为最大值。结论 当PTC患者出现男性、最大径≥8.5 mm、纵横比≥1、微钙化、病灶靠近被膜及BRAFV600E(+)的危险因素时，应高度重视，尽早行预防性中央区淋巴结清扫。
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关键词:
- 甲状腺乳头状癌 /
- BRAFV600E基因 /
- 淋巴结转移 /
- 超声特征
Abstract: Objective To investigate whether central lymph node metastasis(CLNM) in the central region of thyroid papillary carcinoma(PTC) is related to conventional ultrasound features of the primary lesion and BRAFV600E gene mutation.Methods A total of 300 patients with PTC confirmed by surgical pathology and central lymph node dissection in the First Affiliated Hospital of Jinzhou Medical University from October 2019 to June 2021 were collected. The subjects were divided into the metastatic group and the non-metastatic group according to whether CLNM occurred. The correlation was determined by analyzing the conventional ultrasound characteristics and BRAFV600E gene test results of the two groups of patients.Results Among 300 PTC patients, 120(40%) had CLNM. Univariate analysis showed that there were statistically significant differences between groups in gender, nodule maximum diameter line, number of lesions, boundaries, morphology, aspect ratio, proximity to the membrane, calcification and BRAFV600E gene mutation(P < 0.05). Logistic multivariate regression analysis showed that gender, maximum diameter line, aspect ratio, proximity to the membrane, microcalcification and BRAFV600E were the risk factors for CLNM in PTC patients(P < 0.05). ROC curve showed that when the maximum diameter was 8.5 mm, the Yooden index was the maximum.Conclusion When the risk factors of male, maximum diameter ≥8.5 mm, aspect ratio ≥1, microcalcification, proximity to capsule and BRAFV600E(+) appear in PTC patients, high attention should be paid to preventive CLN dissection as soon as possible. -
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表 1 300例PTC患者常规超声特征及BRAFV600E基因突变与CLNM的单因素分析
研究因素 转移组(n=120) 非转移组(n=180) χ2/t P值 研究因素 转移组(n=120) 非转移组(n=180) χ2/t P值 年龄/岁 44±12 47±10 1.865 >0.05 纵横比 4.504 ＜0.05 性别 10.192 ＜0.01 ≥1 90(44.1) 114(55.9) 男 39(56.5) 30(43.5) ＜1 30(31.2) 66(68.8) 女 81(35.1) 150(64.9) 钙化 43.637 ＜0.01 结节数目 10.133 ＜0.01 无钙化 33(23.9) 105(76.1) 单发 69(33.8) 135(66.2) 微钙化 64(53.3) 56(46.7) 多发 51(53.1) 45(46.9) 粗钙化 10(34.5) 19(65.5) 最大径线/mm 11.4±7.9 7.5±4.3 4.922 ＜0.01 微-粗钙化 13(100.0) 0(0.0) 内回声 6.623 >0.05 位置 1.753 >0.05 极低回声 7(46.7) 8(53.3) 上极 26(35.1) 48(64.9) 低回声 102(38.5) 163(61.5) 中极 37(38.5) 59(61.5) 等回声 7(43.8) 9(56.2) 下极 46(44.7) 57(55.3) 强弱不均 4(100.0) 0(0.0) 峡部 11(40.7) 16(59.3) 边界 6.001 ＜0.05 合并桥本病 3.172 >0.05 清 25(29.1) 61(70.9) 是 17(54.8) 14(45.2) 不清 95(44.4) 119(55.6) 否 103(38.3) 166(61.7) 形态 4.792 ＜0.05 BRAFV600E 15.137 ＜0.01 规整 26(30.2) 60(69.8) 阳性 97(47.5) 107(52.5) 不规整 94(43.9) 120(56.1) 阴性 23(24.0) 73(76.0) 靠近被膜 46.808 ＜0.01 是 76(63.9) 43(36.1) 否 44(24.3) 137(75.7) 
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表 2 多因素Logistic回归分析CLNM的危险因素
研究因素 回归系数 标准误 Wald值 P值 OR值 95%CI 性别 0.766 0.352 4.742 ＜0.05 2.152 1.080~4.289 最大径线 0.086 0.033 6.874 ＜0.01 0.918 0.861~0.979 病灶数 0.515 0.328 2.467 >0.05 0.597 0.314~1.136 边界 0.194 0.351 0.307 >0.05 0.823 0.414~1.637 形态 0.033 0.359 0.008 >0.05 1.034 0.511~2.090 纵横比 0.822 0.350 5.517 ＜0.05 2.275 1.146~4.515 靠近被膜 1.508 0.310 23.617 ＜0.01 4.518 2.459~8.301 BRAFV600E 0.794 0.340 5.445 ＜0.05 2.212 1.135~4.308 微钙化 1.099 0.325 11.440 ＜0.01 0.333 0.176~0.630
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