摘要
目的对BRAF_(V600E)基因在中国甲状腺乳头状癌(PTC)患者中的突变率及其与PTC患者临床病理学特征之间的关系进行系统评价。方法依据定义的选择标准检索2014年1月以前Pub Med、Embase、维普数据库、中国生物医学文献数据库、万方数据库、中国知网数据库的期刊文献,评价纳入研究质量,提取有效数据。采用RevMan 5.1软件进行Meta分析。结果 46篇文献纳入分析,共5 831例PTC患者进行了BRAFV600E基因突变探测,突变率为25%~83%,总的突变率为54.6%。5 542例患者纳入了BRAFV600E基因突变与PTC临床病理学特征之间关系的研究,Meta分析显示BRAFV600E基因突变与传统组织亚型[OR=2.30,95%CI(1.32,4.01),P=0.003]、滤泡组织亚型[OR=0.44,95%CI(0.23,0.86),P=0.02]、甲状腺外浸润[OR=2.18,95%CI(1.83,2.59),P<0.000 01]、多灶性[OR=1.31,95%CI(1.07,1.60),P=0.009]、淋巴细胞性甲状腺炎[OR=0.31,95%CI(0.23,0.42),P<0.000 01]、淋巴结转移[OR=1.95,95%CI(1.40,2.72),P<0.000 1]、高TNM分期[OR=2.41,95%CI(2.01,2.88),P<0.000 01]和复发[OR=3.22,95%CI(2.04,5.09),P<0.000 01]的关系具有统计学意义;而与性别、年龄≥45岁、平均年龄、肿瘤直径≥10 mm、平均肿瘤大小、高细胞组织亚型和远处转移的关系不具有统计学意义(P>0.05)。结论在中国PTC患者中,BRAFV600E基因突变阳性的PTC具有较差的临床病理学特征;BRAFV600E基因突变可以作为中国PTC患者的一个预后评估指标。
Objective To evaluate the frequency of BRAF_（V600E） mutation and the association between BRAFV600 Emutation and clinicopathologic characteristics of papillary thyroid carcinoma（PTC） in Chinese population by Meta-analysis. Methods The relevant published studies before January 2014 were reviewed according to the defined selection criteria using the Pub Med, Embase, VIP, China Biology Medicine Database, Wanfang and China Knowledge Resource Integrated Database. The effect sizes of outcome parameters were estimated by odds ratio（OR） or weighted mean difference with a 95% confidence interval（CI）. The quality of the included trials was assessed and Meta-analyses were conducted by Rev Man 5.1 software. Results The study included 46 studies with a total of 5 831 patients. The prevalence of BRAFV600 E mutation ranged from 25% to 83%, with an overall prevalence of 54.6%. The clinicopathologic characteristics of 5 542 patients were analyzed. There were statistical significances in association between BRAFV600 Emutation and the presence of classical type [OR=2.30, 95%CI（1.32, 4.01）, P=0.003], follicular type [OR=0.44, 95%CI（0.23, 0.86）, P=0.02], extrathyroidal extension [OR=2.18, 95%CI（1.83, 2.59）, P〈0.000 01], multifocality [OR=1.31, 95%CI（1.07, 1.60）, P=0.009], lymphocytic thyroiditis [OR=0.31, 95%CI（0.23, 0.42）, P〈0.000 01], lymph node metastasis [OR=1.95, 95%CI（1.40, 2.72）, P〈0.000 1], advanced TNM stage [OR=2.41, 95%CI（2.01, 2.88）, P〈0.000 01] and recurrence [OR=3.22, 95%CI（2.04, 5.09）, P〈0.000 01], but the correlation of BRAFV600 E mutation was not significant with gender, mean age, mean tumor size, age being ≥ 45 years, tumor size being ≥ 10 mm, tall cell type, and distant metastases（P〈0.05）. Conclusions In Chinese patients, PTC with BRAFV600 E mutation has more aggressive clinicopathologic characteristics than that without BRAFV600 E mutation. The BRAFV600 E mutation may be used as an important prognostic marker for patients with PTC.
出处
《华西医学》
CAS
2016年第3期467-479,共13页
West China Medical Journal
基金
四川省科技厅项目(2013SZ0041)~~
