Low-invasive somatic oncogenes and lymph node metastasis in pediatric papillary thyroid cancer: implications for prophylactic central neck dissection.

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM European Thyroid Journal Pub Date : 2024-08-02 Print Date: 2024-08-01 DOI:10.1530/ETJ-23-0265
Julia A Baran, Mya Bojarsky, Stephen Halada, Julio C Ricarte-Filho, Amber Isaza, Aime T Franco, Lea F Surrey, Tricia Bhatti, Zubair Baloch, N Scott Adzick, Sogol Mostoufi-Moab, Ken Kazahaya, Andrew J Bauer
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引用次数: 0

Abstract

Objective: The American Thyroid Association (ATA) Pediatric Guidelines recommend selective, prophylactic central neck dissection (pCND) for patients with papillary thyroid carcinoma (PTC) based on tumor focality, tumor size, and the surgeon's experience. With the expansion of pre-surgical somatic oncogene testing and continued controversy over the benefits of pCND, oncogenic alteration data may provide an opportunity to stratify pCND. This study compared lymph node (LN) involvement in pediatric patients with PTC between tumors with low- and high-invasive-associated alterations to explore the potential utility of preoperative oncogenic alterations in the stratification of pCND.

Methods: This is retrospective cohort study of pediatric patients who underwent somatic oncogene testing post thyroidectomy for PTC between July 2003 and July 2022.

Results: Of 192 eligible PTC patients with postoperative somatic oncogene data, 19 tumors harbored somatic alterations associated with low-invasive disease (19/192, 10%), and 128 tumors harbored a BRAFV600E alteration (45/192, 23%) or an oncogenic fusion (83/192, 43%). Tumors with low-invasive alterations were less likely to present malignant preoperative cytology (2/18, 11%) than those with high-invasive alterations (97/124, 78%; P < 0.001). Twelve patients with low-invasive alterations had LNs dissected from the central neck (12/19, 63%) compared to 127 patients (127/128, 99%) with high-invasive alterations. LN metastasis was identified in two patients with low-invasive alterations (2/19, 11%) compared to 107 patients with high-invasive alterations (107/128, 84%; P < 0.001).

Conclusion: Pediatric patients with low-invasive somatic oncogenic alterations are at low risk for metastasis to central neck LNs. Our findings suggest that preoperative knowledge of somatic oncogene alterations provides objective data to stratify pediatric patients who may not benefit from pCND.

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小儿甲状腺乳头状癌中的低侵袭性体细胞癌基因和淋巴结转移:预防性中央颈部切除术的意义》。
目的:美国甲状腺协会(ATA)儿科指南建议根据肿瘤病灶、肿瘤大小和外科医生的经验对甲状腺乳头状癌(PTC)患者进行选择性、预防性颈部中央切除术(pCND)。随着手术前体细胞癌基因检测的扩大,以及对pCND益处的持续争议,癌基因改变数据可能为pCND分层提供了机会。本研究比较了具有低侵袭性相关改变和高侵袭性相关改变肿瘤的儿科PTC患者淋巴结(LN)受累情况,以探索术前致癌基因改变在pCND分层中的潜在作用:方法:对2003年7月至2022年7月期间因PTC接受甲状腺切除术后体细胞癌基因检测的儿科患者进行回顾性队列研究:结果:在192例符合条件且有术后体细胞癌基因数据的PTC患者中,19例肿瘤存在与低侵袭性疾病相关的体细胞改变(19/192,10%),128例肿瘤存在BRAFV600E改变(45/192,23%)或致癌融合(83/192,43%)。与高侵袭性改变的肿瘤(97/124,78%;P结论)相比,低侵袭性改变的肿瘤术前细胞学恶性程度较低(2/18,11%):低侵袭性体细胞致癌基因改变的小儿患者向颈部中央淋巴结转移的风险较低。我们的研究结果表明,术前对体细胞癌基因改变的了解可提供客观数据,对可能无法从pCND中获益的儿科患者进行分层。
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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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