Abstract:
Objective To investigate the indications of lateral neck lymph node dissection in patients with papillary thyroid carcinoma harboring BRAFV600E mutations.
Methods From January 2018 to August 2019, 80 patients with papillary microcarcinoma who underwent total thyroidectomy and lateral neck lymph node dissection at Sichuan Cancer Hospital & Cancer Institute were retrospectively analyzed.The BRAFV600E gene was sequenced, and patients were assigned into the gene mutation group (group A) and the no-gene mutation group (Group B) based on sequencing results.There was no significant difference in the preoperative age and sex, so as to explore the cervical lymph node metastasis after surgery; stage Ⅱ : Fifty patients with BRAFV600E mutations were assigned into two groups: the lymph node metastasis group (Group C) and the no-metastasis group (Group D).Univariate and multivariate analyses according to sex, age, tumor diameter, tumor location, thyroglobulin levels, anti-thyroglobulin antibody levels, tumor invasion, thyroid function, tumor multifocality, and central lymph node metastasis were performed.
Results Among the 80 patients, 50 had BRAFV600E mutations (group A), while 30 did not (group B).There were no significant differences in preoperative age, sex, thyroid function, tumor location, and multifocality between groups A and B (P > 0.05).Postoperative cervical lymph node metastasis was significantly more frequent in group A than in group B (60% vs.27%, P=0.004).Among patients with BRAFV600E mutations, 12(24%) had lateral neck metastasis (P=0.038), 20(40%) had central lymph node metastasis with lateral neck lymph node metastasis(P=0.011), 19 (38%) had lateral neck lymph node metastasis (P=0.049). And 19(38%) had lateral neck metastasis with tumor diameter greater than 7.5 mm(38%)(P=0.021); there were no statistically significant differences in gender, presence of Hashimoto's thyroiditis, thyroglobulin, anti-thyroglobulin antibodies, tumor invasion, and multifocal status of ipsilateral cervical lymph node metastasis (P > 0.05).
Conclusions Patients with BRAFV600E mutations were more likely to develop lateral cervical lymph node metastasis.Age < 55 years, tumor diameter ≥7.5 mm, tumor located in the upper, middle, and central neck regions were risk factors for lateral cervical lymph node metastasis in papillary thyroid carcinoma harboring BRAFV600E gene mutations.