Papillary thyroid carcinomas with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension Journal Article

   

Authors:	Ricarte-Filho, J.; Ganly, I.; Rivera, M.; Katabi, N.; Fu, W.; Shaha, A.; Tuttle, R. M.; Fagin, J. A.; Ghossein, R.
Article Title:	Papillary thyroid carcinomas with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension
Abstract:	Background: Papillary thyroid carcinoma (PTC) patients presenting with cervical lymph nodes (LN) metastases (M) have a variable outcome. The objective of this study is to assess the value of meticulous histopathologic examination and genotyping in stratifying these patients into clinically relevant prognostic subgroups. Methods: This was a retrospective clinical and histopathological review of PTC patients with lymph node metastases at presentation identified between 1980 and 2002 in a single institution. Primary tumors from patients who later recurred were matched to a group of patients who did not recur and subjected to mass spectrometry genotyping encompassing the most significant oncogenes in thyroid carcinomas. Results: There were 246 patients who satisfied the inclusion criteria. The median follow-up was 10.8 years. The presence of >3 metastatic nodes was an independent predictor of decreased recurrence free survival (p=0.03). In patients <45 years, none of 45 with 1-2 metastatic LN recurred, including 26 patients followed for a median of 13 years without radioactive iodine (RAI) therapy. BRAF mutations were found in 28 (78%) of 36 genotyped tumors. Combined positivity for BRAF and extra-nodal extension was much stronger in predicting disease specific survival (DSS) (p=0.004) than the single analysis of BRAF (p=0.12) or extra-nodal extension (p=0.02). Conclusions: (i) The number of metastatic LN is an independent predictor of recurrence in all age groups and identifies a subset of young patients with excellent prognosis who may not benefit from RAI therapy. (ii) Combined positivity for BRAF and extra-nodal extension has additive prognostic value in predicting DSS. (iii) Classification systems that assign the same magnitude of risk for recurrence or death to all patients with N1 disease should be revisited. © Copyright 2012, Mary Ann Liebert, Inc. 2012.
Keywords:	adult; controlled study; middle aged; primary tumor; survival rate; retrospective studies; gene mutation; major clinical study; mutation; histopathology; cancer recurrence; cancer risk; disease classification; cancer patient; follow up; follow-up studies; lymph node metastasis; lymph nodes; lymphatic metastasis; mass spectrometry; neoplasm recurrence, local; genotype; medical record review; oncogene; radioactive iodine; iodine radioisotopes; carcinoma; predictive value of tests; predictor variable; thyroid carcinoma; thyroid neoplasms; cervical lymph node; b raf kinase; disease specific survival; proto-oncogene proteins b-raf; recurrence free survival; fatality; survival prediction; cancer prognosis
Journal Title:	Thyroid
Volume:	22
Issue:	6
ISSN:	1050-7256
Publisher:	Mary Ann Liebert, Inc
Date Published:	2012-06-01
Start Page:	575
End Page:	584
Language:	English
DOI:	10.1089/thy.2011.0431
PROVIDER:	scopus
PUBMED:	22471242
PMCID:	PMC5206680
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84861988936&partnerID=40&md5=624dec3aa9147e6954fe3ff82d4b8433
Notes:	--- - "Export Date: 2 July 2012" - "CODEN: THYRE" - "Source: Scopus"

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