title: Impact of clinical risk scores and BRAF V600E mutation status on outcome in papillary thyroid cancer.
abstract: BACKGROUND
  To evaluate the relationship between the BRAF V600E mutation and clinicopathologic parameters and to assess the impact of the BRAF V600E mutation and established risk scores on survival in patients with papillary thyroid carcinoma (PTC).
  
  
  METHODS
  Retrospective analysis of a consecutive, single-institutional cohort of patients with PTC larger than 1 cm. Clinical risk scores according to the Metastases, Age, Completeness of Resection, Invasion, Size (MACIS), European Organisation for Research and Treatment of Cancer (EORTC), and tumor, node, metastases (TNM) scoring systems were determined. BRAF exon 15 mutation analysis was performed by polymerase chain reaction and Sanger sequencing.
  
  
  RESULTS
  BRAF V600E mutations were found in 75/116 (65%) PTC. The rates for 5- and 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were 92% and 87%, 98% and 96%, and 96% and 94%, respectively. Low MACIS scores were associated with longer OS (10 y 95% vs 75%, P = .008), DSS (10 y 100% vs 89%, P = .02) and RFS (100% vs 85%, P = .006). Comparable survival advantages were observed for patients with early EORTC scores and low TNM stage. BRAF V600E mutation status was not associated with clinicopathologic characteristics of aggressive behavior such as extrathyroidal extension, lymph node metastases, higher T-categories, male sex, and greater age. Furthermore, BRAF V600E mutation status was not correlated with clinical risk scores and decreased survival.
  
  
  CONCLUSIONS
  In concordance with other studies, we did not find a negative prognostic impact of a positive BRAF V600E mutation status on survival. In contrast, the risk algorithms MACIS, EORTC score, and TNM stage were associated with impaired prognosis. Therefore, clinical staging systems represent better tools for risk stratification than BRAF V600E mutation status.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Séverine M
authors.initials: SM
authors.lastname: Niederer-Wüst
authors.affiliation: Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.affiliation: Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Diana
authors.initials: D
authors.lastname: Förbs
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Brändle
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bilz
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clerici
authors.affiliation: Department of Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Oettli
authors.affiliation: Department of Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Joachim
authors.initials: J
authors.lastname: Müller
authors.affiliation: Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Haile
authors.affiliation: Cancer Registry Eastern Switzerland, St. Gallen, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ess
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Sandro J
authors.initials: SJ
authors.lastname: Stoeckli
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. Electronic address: martina.broglie@kssg.ch.
authors.forename: Martina A
authors.initials: MA
authors.lastname: Broglie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D002291:Carcinoma, Papillary; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D012189:Retrospective Studies; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf