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目的:探讨乳头状甲状腺癌(PTC)中BRAF基因突变的临床意义。方法:选择2年间符合条件的PTC手术患者126例,提取患者石蜡切片中的DNA样本,用荧光PCR法检测BRAF基因V600E(BRAFV600E)的突变情况,分析BRAFV600E突变与PTC患者临床病理因素及中央区淋巴结转移的关系。结果:126例PTC患者BRAFV600E突变的发生率为69.0%(87/126)。单因素与多因素分析显示,BRAFV600E突变与淋巴结转移有关(P<0.05);中央区淋巴结转移与年龄、肿瘤大小、肿瘤分期和BRAFV600E突变有关(均P<0.05)。进一步分析显示,肿瘤直径≤10 mm时,BRAFV600E突变与中央区淋巴结转移无关(P>0.05),肿瘤直径>10 mm时,BRAFV600E突变患者的中央区淋巴结转移率高于突变阴性患者(P<0.05)。结论:BRAFV600E突变是PTC中央区淋巴结转移风险的独立预测因子;对于术前检测BRAFV600E突变阳性患者,肿瘤直径越大越应该重视中央区淋巴结清扫。
Objective: To investigate the clinical significance of BRAF gene mutation in papillary thyroid carcinoma (PTC). Methods: A total of 126 patients who underwent PTC surgery during 2 years were recruited. The DNA samples of paraffin sections of patients were collected. The mutation of BRAFV600E was detected by fluorescence PCR. The clinical and pathological features of BRAFV600E mutation and central area Lymph node metastasis. Results: The incidence of BRAFV600E mutation in 126 PTC patients was 69.0% (87/126). Univariate and multivariate analysis showed that BRAFV600E mutation was associated with lymph node metastasis (P <0.05). The central lymph node metastasis was related to age, tumor size, tumor stage and BRAFV600E mutation (all P <0.05). Further analysis showed that BRAFV600E mutation had no relation with central lymph node metastasis (P> 0.05) when the diameter of tumor was less than 10 mm, and the central lymph node metastasis rate was higher in patients with BRAFV600E mutation than those with negative mutation (P <0.05) ). Conclusion: The BRAFV600E mutation is an independent predictor of lymph node metastasis in the central region of PTC. For the patients with positive BRAFV600E mutation before surgery, the larger the tumor diameter, the more attention should be paid to the central lymph node dissection.