title: Clinicopathological Features and Prognosis of Papillary Thyroid Microcarcinoma for Surgery and Relationships with the BRAFV600E Mutational Status and Expression of Angiogenic Factors.
abstract: OBJECTIVE
  To investigate the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) for surgery by comparing the difference between PTMC and larger papillary thyroid carcinoma (LPTC).
  
  
  METHODS
  We analyzed the differences in the clinicopathological characteristics, prognosis, B-type RAF kinase (BRAF)V600E mutational status and expression of angiogenic factors, including pigment epithelium-derived factor (PEDF), Vascular Endothelial Growth Factor (VEGF), and hypoxia-inducible factor alpha subunit (HIF-1α), between PTMC and LPTC by retrospectively reviewing the records of 251 patients with papillary thyroid carcinoma, 169 with PTMC, and 82 with LPTC (diameter >1 cm).
  
  
  RESULTS
  There were no significant differences in the gender, age, multifocality, Hashimoto's thyroiditis, TNM stage, PEDF protein expression, rate of recurrence, or mean follow-up duration between patients with PTMC or LPTC. The prevalence of extrathyroidal invasion (EI), lymph node metastasis (LNM), and BRAF mutation in patients with PTMC was significantly lower than in patients with LPTC. In addition, in PTMC patients with EI and/or LNM and/or positive BRAF (high-risk PTMC patients), the prevalence of extrathyroidal invasion, Hashimoto's disease, lymph node metastasis, tumor TNM stage, PEDF positive protein expression, the rate of recurrent disease, and the mRNA expression of anti-angiogenic factors was almost as high as in patients with larger PTC, but with no significant difference.
  
  
  CONCLUSIONS
  Extrathyroid invasion, lymph node metastases, and BRAFV600E mutation were the high risk factors of PTMC. PTMC should be considered for the same treatment strategy as LPTC when any of these factors is found. Particularly, PTMC with BRAFV600E gene mutations needed earlier surgical treatment. In addition, the high cell subtype of PTMC with BRAFV600E gene mutation is recommended for total thyroidectomy in primary surgery to reduce the risk of recurrence.
authors.affiliation: Department of breast surgery, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China.|The Fourth Department of General Surgery, the Second Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Chenlei
authors.initials: C
authors.lastname: Shi
authors.affiliation: Department of Breast and Thyroid, Heze Municipal Hospital, Shandong Province, Heze, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Guo
authors.affiliation: The Fourth Department of General Surgery, the Second Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Yichen
authors.initials: Y
authors.lastname: Lv
authors.affiliation: The Pathology Department, the Third Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Abiyasi
authors.initials: A
authors.lastname: Nanding
authors.affiliation: The Fourth Department of General Surgery, the Second Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Tiefeng
authors.initials: T
authors.lastname: Shi
authors.affiliation: The Fourth Department of General Surgery, the Second Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Huadong
authors.initials: H
authors.lastname: Qin
authors.affiliation: Department of breast surgery, the First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000175:diagnosis / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D005136:Eye Proteins / Q000235:genetics; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000235:genetics; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000235:genetics / Q000473:pathology; D009414:Nerve Growth Factors / Q000235:genetics; D017354:Point Mutation; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D015843:Serpins / Q000235:genetics; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics; D000099174:Pigment Epithelium-Derived Factor
chemical_list: D005136:Eye Proteins; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D009414:Nerve Growth Factors; D048493:Proto-Oncogene Proteins B-raf; D015843:Serpins; D042461:Vascular Endothelial Growth Factor A; D000099174:Pigment Epithelium-Derived Factor; C497442:HIF1A protein, human; C482119:BRAF protein, human