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.

Prognostic value of lymph node ratio in metastatic papillary thyroid carcinoma

“…9 However, other population-based studies demonstrated a negative effect on survival, with varying levels of significance. 3,[10][11][12][13] The current 2016 American Joint Committee on Cancer tumour-node-metastasis (TNM) staging system for papillary thyroid carcinoma incorporates only the presence and laterality of regional lymph nodes, yet prognosis is affected only in patients older than 45 years. Moreover, it was originally developed to predict risk for mortality rather than recurrence.…”

Metastatic lymph node characteristics as predictors of recurrence/persistence in the neck and distant metastases in differentiated thyroid cancer

“…Two hundred and eight As also shown in Table 1, the median follow-up was 6.2 years (0. [8][9][10][11][12][13][14][15][16][17]. At the end of follow-up, 89 patients (42.2%) were disease-free, 74 (35.1%) maintained biochemical disease, 43 (20.4%) had structural persistence, and 5 (2.4%) died from the disease.…”

Associations of the BRAF (V600E) mutation and p53 protein expression with clinicopathological features of papillary thyroid carcinomas patients

“…Furthermore, multiple previous studies have demonstrated a correlation between the BRAF (V600E) mutation and the high-risk clinicopathological characteristics of PTC, including older age at diagnosis, male gender, large tumor size, the presence of extrathyroidal extension, lymph node and distant metastasis and an advanced stage (9)(10)(11)13,15,16,(18)(19)(20)28,29). By contrast, certain studies were unable to identify marked associations between the BRAF (V600E) mutation and the high-risk clinicopathological characteristics of PTC (12,14).…”

“…Numerous studies have evaluated the association between the BRAF (V600E) mutation, clinicopathological features and clinical outcomes of PTC; however, controversial results have been obtained for a correlation between the BRAF (V600E) mutation and clinicopathological features (1,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Furthermore, multiple previous studies have demonstrated a correlation between the BRAF (V600E) mutation and the high-risk clinicopathological characteristics of PTC, including older age at diagnosis, male gender, large tumor size, the presence of extrathyroidal extension, lymph node and distant metastasis and an advanced stage (9)(10)(11)13,15,16,(18)(19)(20)28,29).…”

“…Numerous studies have investigated potential associations among the BRAF (V600E) mutation, clinicopathological features of PTC and the clinical outcome of patients; however, correlations between the incidence of the BRAF (V600E) mutation and clinicopathological features in PTC patients remains controversial (1,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”