Thyroid Cancer 101: How Thyroid Peroxidase Antibody TPO ab and BRAFV600V Status Changes Prognosis.
DR. Guttler’s comments:
- Chronic thyroiditis CHT is associated with a better prognosis in thyroid cancer patients.
- The presence of targeted lymophocytes to destroy thyroid cells in CHT also seem to attack the thyroid cancer cells.
- The TPO ab positive cancer patients even do better with more aggressive multifocal BRAFV600V positive compared to when the TPOab is negative.
- Having CHT and positive TPO ab is a sign of a better prognosis even with BRAFV600V is also positive.
- Most common inPapillary thyroid cancer has BRAF mutation and translocation RET /PTC.
- CHT has a higher risk of papillary thyroid cancer due to presence of RET/PTC translocation.
- Presence of CHT results in a lower death rate of from PTC.
Association between diffuse lymphocytic infiltration and papillary thyroid cancer aggressiveness according to the presence of thyroid peroxidase antibody and BRAFV600E mutation
Young Ki Lee MD
Diffuse lymphocytic infiltration (DLI) is frequently found with papillary thyroid cancer (PTC), so there has been long interest in how it affects the characteristics of PTC. This purpose of this study was to define the association between DLI and PTC aggressiveness according to thyroperoxidase antibody (TPOAb) and B‐type Raf (BRAF)V600E mutation positivity.
There were 1879 patients with PTC who underwent surgery and were enrolled in this study. Clinicopathologic characteristics were compared between groups according to the presence of DLI and TPOAb. Multiple logistic regression analysis was conducted to assess odds ratio (OR) for each dependent variable (BRAFV600E mutation, tumor size >1.0 cm, multifocality, extrathyroidal extension, and lymph node metastasis) of each group according to the presence of DLI and TPOAb, with the group with neither DLI or TPOAb (DLI‐negative TPOAb‐negative PTC) as the reference.
The DLI‐positive PTC showed more frequent multifocality and less frequent BRAFV600E mutation than DLI‐negative PTC. Among patients with DLI‐positive PTC, extrathyroidal extension and BRAFV600E mutation was less frequent when serum TPOAb was positive. In multiple logistic regressions, DLI‐positive TPOAb‐positive PTC showed a high OR for multifocality (1.410; P = .017), but low ORs for BRAFV600Emutation (0.521; P < .001) and extrathyroidal extension (0.691; P = .008). The patients with DLI‐positive TPOAb‐positive PTCs showed a high OR for multifocality (1.588; P = .002), and high ORs for tumor size >1.0 cm (2.205; P = .019) and lymph node metastasis (2.005; P = .032) in subgroup analyses of PTC with wild‐type BRAF. The DLI‐negative TPOAb‐positive group was not associated with any tumor aggressiveness‐related variables.
Although DLI was associated with multifocality regardless of TPOAb positivity, it was associated with an indolent feature when TPOAb was positive but with aggressive features in PTC with wild‐type BRAF when TPOAb was negative. The TPOAb and BRAF status may help to define the clinical implication of lymphocytic infiltration found with PTC.
Image: Lymphocytes surrounding thyroid follicles in Chronic Thyroiditis.