Оптимизация хирургической тактики лечения BRAF-положительного папиллярного рака щитовидной железы

Abstract

Backgraund. Papillary thyroid cancer (PTC) has a favorable course and low mortality rates. However, the incidence of morbidity and mortality continues to increase, especially in the high-risk group. BRAF mutation is a marker of the PTC aggressive course. Aims. Тo study the relationship between surgical treatment tactics and the BRAF positive PTC prognosis. Materials and methods. Our prospective study included 80 patients with BRAF positive PTC, operated from 2009 to 2016 y. Surgical tactics were determined by existing clinical guidelines. To the patients with BRAF positive thyroid cancer it is proposed to perform thyroidectomy with central compartment lymph node dissection. BRAF status was determined by the PCR method in fine needle aspiration biopsy material (FNAB). Results. Recurrence was detected in 7 of the 18 patients of the hemi/thyroidectomy group. Among 62 patients from the group of thyroidectomy with central compartment lymph node dissection recurrence was detected only in 3 cases. The mean recurrence time also differed significantly, and in the group of patients with (hemi)thyroidectomy without central compartment lymph node dissection is detected earlier (53 months and 59.61 months). Also, organ-preserving operations without central compartment lymph node dissection in BRAF positive tumor has worse result, regardless of T stage. Conclusions. In the presence of BRAF-positive PTC thyroidectomy with central compartment lymph node dissection is indicated.