A meta-analysis of prognostic roles of molecular markers in papillary thyroid carcinoma.
A meta-analysis of prognostic roles of molecular markers in papillary thyroid carcinoma.
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DOI：
10.1530/ec-17-0010
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发表时间：
2017-04
影响因子：
2.9
通讯作者：
Hassell L
中科院分区：
文献类型：
--
作者：
Vuong HG;Duong UN;Altibi AM;Ngo HT;Pham TQ;Tran HM;Gandolfi G;Hassell L
分子标记物在甲状腺乳头状癌（PTC）预后中的作用是一个持续争论的问题。本研究旨在探讨RAS、BRAF、TERT启动子突变和RET/PTC重排对PTC患者预后的影响。我们在四个电子数据库中进行了检索：PubMed、Scopus、Web of Science和虚拟健康图书馆（VHL）。疾病特异性生存期（DSS）和无病生存期（DFS）的风险比（HR）及其95%可信区间（CI）数据直接来源于原始文献或间接来源于Kaplan-Meier曲线（KMC）。使用随机效应模型通过逆方差法加权计算合并HR。通过Egger回归检验和漏斗图的目视检查评估发表偏倚。从2630项研究中，我们最终纳入了35项研究，17,732例患者进行荟萃分析。TERT启动子突变与不良DSS（HR = 7.64; 95%CI = 4.00-14.61）和DFS（HR = 2.98; 95%CI = 2.27-3.92）显著相关。BRAF突变显著增加复发风险（HR = 1.63; 95% CI = 1.27-2.10），但不增加癌症死亡率（HR = 1.41; 95% CI = 0.90-2.23）。在亚组分析中，BRAF突变仅在中短期随访中显示其预后价值。关于RAS突变和RET/PTC融合的数据不足以进行荟萃分析。TERT基因启动子突变可作为一个独立、可靠的危险分层和预后预测指标。使用BRAF突变评估患者预后应慎重考虑。
The prognostic role of molecular markers in papillary thyroid carcinoma (PTC) is a matter of ongoing debate. The aim of our study is to investigate the impact of RAS, BRAF, TERT promoter mutations and RET/PTC rearrangements on the prognosis of PTC patients. We performed a search in four electronic databases: PubMed, Scopus, Web of Science and Virtual Health Library (VHL). Data of hazard ratio (HR) and its 95% confidence interval (CI) for disease-specific survival (DSS) and disease-free survival (DFS) were directly obtained from original papers or indirectly estimated from Kaplan–Meier curve (KMC). Pooled HRs were calculated using random-effect model weighted by inverse variance method. Publication bias was assessed by using Egger’s regression test and visual inspection of funnel plots. From 2630 studies, we finally included 35 studies with 17,732 patients for meta-analyses. TERT promoter mutation was significantly associated with unfavorable DSS (HR = 7.64; 95% CI = 4.00–14.61) and DFS (HR = 2.98; 95% CI = 2.27–3.92). BRAF mutations significantly increased the risk for recurrence (HR = 1.63; 95% CI = 1.27–2.10) but not for cancer mortality (HR = 1.41; 95% CI = 0.90–2.23). In subgroup analyses, BRAF mutation only showed its prognostic value in short-/medium-term follow-up. Data regarding RAS mutations and RET/PTC fusions were insufficient for meta-analyses. TERT promoter mutation can be used as an independent and reliable marker for risk stratification and predicting patient’s outcomes. The use of BRAF mutation to assess patient prognosis should be carefully considered.