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BRAF V600E status may facilitate decision-making on active surveillance of low-risk papillary thyroid microcarcinoma
KJ. Kim, SG. Kim, J. Tan, X. Shen, D. Viola, R. Elisei, E. Puxeddu, L. Fugazzola, C. Colombo, B. Jarzab, A. Czarniecka, AK. Lam, C. Mian, F. Vianello, L. Yip, G. Riesco-Eizaguirre, P. Santisteban, CJ. O'Neill, MS. Sywak, R. Clifton-Bligh, B....
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články, Research Support, N.I.H., Extramural, práce podpořená grantem
Grantová podpora
NV16-32665A
MZ0
CEP - Centrální evidence projektů
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory štítné žlázy genetika MeSH
- papilární karcinom genetika MeSH
- pozorné vyčkávání metody MeSH
- prognóza MeSH
- protoonkogenní proteiny B-raf genetika MeSH
- rozhodování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
INTRODUCTION: Conservative active surveillance has been proposed for low-risk papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm and lacking clinical aggressive features, but controversy exists with accepting it as not all such PTMCs are uniformly destined for benign prognosis. This study investigated whether BRAF V600E status could further risk stratify PTMC, particularly low-risk PTMC, and can thus help with more accurate case selection for conservative management. METHODS: This international multicenter study included 743 patients treated with total thyroidectomy for PTMC (584 women and 159 men), with a median age of 49 years (interquartile range [IQR], 39-59 years) and a median follow-up time of 53 months (IQR, 25-93 months). RESULTS: On overall analyses of all PTMCs, tumour recurrences were 6.4% (32/502) versus 10.8% (26/241) in BRAF mutation-negative versus BRAF mutation-positive patients (P = 0.041), with a hazard ratio (HR) of 2.44 (95% CI (confidence interval), 1.15-5.20) after multivariate adjustment for confounding clinical factors. On the analyses of low-risk PTMC, recurrences were 1.3% (5/383) versus 4.3% (6/139) in BRAF mutation-negative versus BRAF mutation-positive patients, with an HR of 6.65 (95% CI, 1.80-24.65) after adjustment for confounding clinical factors. BRAF mutation was associated with a significant decline in the Kaplan-Meier recurrence-free survival curve in low-risk PTMC. CONCLUSIONS: BRAF V600E differentiates the recurrence risk of PTMC, particularly low-risk PTMC. Given the robust negative predictive value, conservative active surveillance of BRAF mutation-negative low-risk PTMC is reasonable whereas the increased recurrence risk and other well-known adverse effects of BRAF V600E make the feasibility of long-term conservative surveillance uncertain for BRAF mutation-positive PTMC.
Ciberonc Health Institute Carlos 3 28029 Madrid Spain
Department of Internal Medicine University of Perugia Perugia Italy
Department of Medicine Endocrinology Unit University of Padua Italy
Department of Molecular Endocrinology Institute of Endocrinology Prague Czech Republic
Endocrine Surgical Unit The University of Sydney Sydney Australia
Maria Sklodowska Curie Institute Oncology Center Gliwice Branch Gliwice Poland
University of Pittsburgh School of Medicine Pittsburgh PA USA
Citace poskytuje Crossref.org
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- $a Kim, Kyeong J $u Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea.
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