BRAF and TERT promoter mutations in the aggressiveness of papillary thyroid carcinoma: a study of 653 patients
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Langping Jin1,*, Endong Chen1,*, Siyang Dong1, Yefeng Cai1, Xiangjian Zhang1, Yili Zhou1, Ruichao Zeng1, Fan Yang1, Chuanmeng Pan1, Yehuan Liu1, Weili Wu2, Mingzhao Xing3, Xiaohua Zhang1, Ouchen Wang1
1Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
2Department of Surgical Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province 325000, China
3Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
*These authors have contributed equally to this work
Ouchen Wang, e-mail: firstname.lastname@example.org
Xiaohua Zhang, e-mail: Zhangxiaohua925@163.com
Keywords: papillary thyroid carcinoma, BRAF V600E mutation, TERT promoter mutation, molecular marker, prognosis
Received: October 09, 2015 Accepted: January 29, 2016 Published: March 01, 2016
The role of telomerase reverse transcriptase (TERT) gene promoter mutations in the aggressiveness of papillary thyroid cancer (PTC) remains to be further investigated. Here we examined the relationship of TERT promoter mutations and BRAF V600E with the clinicopathological features of PTC in 653 patients. Sanger sequencing of genomic DNA from primary PTC tumors was performed for mutation detection and genotype-clinicopathological correlation of the tumor was analyzed. BRAF V600E and TERT promoter mutations were found in 63.7% (416 of 653) and 4.1% (27 of 653) of patients, respectively; the latter became 9.8% when only tumors ≥ 1.5 cm were analyzed. TERT promoter mutations occurred more frequently in BRAF mutation-positive cases compared to wild-type cases, being 5.3% in the former versus 2.1% in the latter (P = 0.050). BRAF and TERT promoter mutations were each significantly associated with high-risk clinicopathological features of PTC, such as old patient age, large tumor size, extrathyroidal invasion, capsular invasion, and advanced disease stages. Coexistence of BRAF V600E and TERT promoter mutations was particularly associated with high-risk clinicopathological features, as exemplified by extrathyroidal invasion seen in 54.5% (12/22) of patients harboring both mutations versus 9.9% (23/232) of patients harboring neither mutation (P < 0.001). Thus, this study, the largest on TERT mutation so far, demonstrates a significant role of BRAF V600E and TERT promoter mutations in the aggressiveness of PTC, which is particularly robust and cooperative when the two mutations coexist. These results, together with previous studies, establish a significant role of these mutations in the aggressiveness of PTC.
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