BRAF mutation and age in differentiated thyroid cancer risk stratification: Two sides of the same coin

Xia

et al. 2022

Clinical Endocrinology

Background: To investigate the relationship between age and cancer-speci c mortality in thyroid cancer (TC) with lungmetastasis.Methods: 1,418 patients with initial distant metastases from Surveillance, Epidemiology and End Results databases were investigated. Patients with median follow-up time of 8 months [interquartile range (IQR), 2-27] and median age of 66 years (IQR, were divided into ve groups by age and the association between age and TC-speci c mortality was analyzed.Results: The TC-speci c mortality rates were 32.78% (118/360), 46.71% (156/334), 53.93% (199/369), 58.96% (158/268) and 82.76% (72/87) for patients with age of ≤55 years,56-65 years, 66-75 years, 76-85 years and >85 years. Kaplan-Meier curves showed that TC-speci c mortality rate was associated with increased age (p < 0.001). Compared with patients ≤55 years, patients of 56-65 years, 66-75 years, 76-85 years and >85 years had signi cantly higher hazard ratios (HRs) of 1.69(1.26-2.26), 1.97 (1.47-2.64), 2.18(1.59-2.99) and 3.24(2.08-5.06) after adjustments for gender, tumor size and radiation therapy (all p < 0.001).In TC with initial lung-metastasis, compared with patients ≤55 years, patients of 56-65 years, 66-75 years, 76-85 years and >85 years had signi cantly higher adjusted HRs of 1.68(1.20-2.36, p=0.003), 2.18(1.57-3.02), 2.16(1.51-3.08) and 2.91(1.79-4.75) (p < 0.001). Similar results could be obtained in papillary thyroid cancer.Conclusions: The TC-speci c mortality increased with age in TC patients with initial lung-metastasis, which suggested that further risk strati cation based on age was necessary for TC over 55 years with lung-metastasis. Individual treatment strategy maybe recommended for patients over 85 years. BackgroundThyroid cancer (TC) is one of the most common endocrine tumors, and its incidence has been increasing in the past four decades(1). At present, its incidence is rising the second fasted among solid tumors and it has become the sixth most common malignancy in female population in the United States(2, 3). TC is divided into two categories according to the cell origin, one arising from endoderm-derived follicular cells, and the other arising from the neural crest-derived C-cells(4). The former category includes differentiated thyroid cancer (DTC) [papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and poorly differentiated TC], and anaplastic thyroid cancer (ATC), while the latter category is known as medullary thyroid cancer (MTC)(4). DTC accounts for approximately 90% of all thyroid cancer types.(4, 5) Clinical character of DTC is usually indolent, while ATC is the most aggressive variant, accounting for about 40% of all deaths from TC(5, 6). The most common metastatic site of TC is lung(7), followed by bone, and occasionally brain and liver(8, 9). DTC is a unique malignancy in which age at diagnosis can be an independent risk factor for prognosis (10,11). In 2016, the American Joint Committee on Cancer (AJCC) released eighth edition of the AJCC/TNM cancer staging manual, and changed the age cutof...

Section: Discussionsupporting

confidence: 68%

Age increased the cancer‐specific mortality risk of thyroid cancer with lung metastasis

Xia

et al. 2022

Clinical Endocrinology

“…Gene mutations of different ages may play an important role in PTC. Therefore, we suggest that the future risk stratification systems incorporate molecular markers in association with age, as has been newly reported (30).…”

Section: Discussionmentioning

confidence: 61%

Multi-gene assay and clinical characteristics research in papillary thyroid carcinoma

Deng¹,

Li²,

Yang³

et al. 2021

Gland Surg

Background: To investigate the significance of multi-gene assay in papillary thyroid carcinoma (PTC) patients in clinical practice.Methods: From April to December 2019, medical records of 68 patients with PTC after the initial surgery were retrospectively collected and analyzed in terms of the relations between gene mutations and clinicopathological characteristics.Results: RET/PTC rearrangement was not detected in BRAF V600E mutation patients (P<0.001).Besides, compared with wild-type patients, BRAF V600E mutation was associated with significantly older age (P=0.001) and a higher rate of extrathyroid invasion (P=0.023). Significantly higher BRAF V600E mutation rates were found in clinical lymph node-negative (P=0.041) and non-metastatic lateral lymph nodes (P=0.027) patients as RET/PTC rearrangement was associated with younger age (P=0.001) and the increasing metastatic number of lymph nodes (P=0.020). Compared to other gene mutations, the multivariate analysis showed that larger tumor size [

“…6,7 Many reports suggest that BRA FV600E mutation denotes a high risk of metastasis and recurrence, and is also associated with the aggressiveness of PTC. [8][9][10][11] These results suggest that BRAF V600E mutation may contribute to the detection of high-risk PTC.…”

Section: Introductionmentioning

confidence: 71%

MRI-Based Texture Analysis for Preoperative Prediction of BRAF V600E Mutation in Papillary Thyroid Carcinoma

Zheng¹,

Hu²,

Wang³

et al. 2023

JMDH

Purpose BRAF V600E mutation can compensate for the low detection rate by fine-needle aspiration (FNA) and is related to aggressiveness and lymph node metastasis. This study aimed to investigate the relationship between texture analysis features based on magnetic resonance imaging (MRI) and mutations. Methods Retrospective analysis was performed on patients with postoperative pathology confirmed papillary thyroid carcinoma (PTC) from 2017 to 2021. One thousand one hundred and thirty-two texture features were extracted from T2-weighted imaging (T2WI) and contrast-enhanced T1-weighted imaging (CE-T1WI) separately by outlining the tumor volume of interest (VOI). Univariate, minimum redundancy maximum relevance (mRMR), and multivariate analyses were used for feature selection to construct 3 models (T2WI, CE-T1WI, and combined model) to predict mutation. The reproducibility between observers was evaluated by intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) analysis was used to assess the performance of models. The diagnostic performance of the optimal cut-off value of models were calculated and validated by 10-fold cross-validation. Results A total of 80 PTCs (22 BRAF V600E wild-type and 58 BRAF V600E mutant) were included in our study. Good interobserver agreement was found on texture features we selected (all ICCs >0.75). The area under the ROC curves (AUCs) for the T2WI model, CE-T1WI model, and combined model were 0.83 (95% CI: 0.75–0.91), 0.83 (95% CI: 0.73–0.90), and 0.88 (95% CI: 0.81–0.94), respectively. The accuracy, sensitivity, specificity, PPV, and NPV were 0.776, 0.679, 0.905, 0.905, and 0.679 for the T2WI model at a cut-off value of 0.674; 0.755, 0.750, 0.762, 0.808, and 0.696 for the CE-T1WI model at a cut-off value of 0.573; 0.816, 0.893, 0.714, 0.806, and 0.833 for the combined model at a cut-off value of 0.420. Conclusion MRI-based texture analysis could be a potential method for predicting BRAF V600E mutation in PTC preoperatively.