BACKGROUND
Papillary thyroid cancer is the most common type of thyroid cancer, and fortunately, it has an excellent prognosis with nearly a 90-100% survival rate. However, papillary thyroid cancer can recur. It is estimated that 10-20% of patients experience a recurrence over 10 years. To identify patients with a higher risk of recurrence, risk scores have been developed and high risk patients often receive additional treatment after surgery, such as radioactive iodine therapy. These risk scores consider factors like sex, age, cancer size, and the spread of cancer to lymph nodes and distant organs.

In the past decade, significant research has focused on the role of key genetic mutations in cancer cells that influence cancer behavior. One such mutation in papillary thyroid cancer is the BRAF V600E mutation. This mutation has been observed in 27-87% of all papillary thyroid cancers. Some studies have found that cancers with the BRAF V600E mutation have a higher risk of spread and recurrence. However, the evidence is conflicting, as other studies have shown that the BRAF V600E mutation is not associated with more aggressive cancer.

Given these conflicting results, the present study examines whether the BRAF V600E mutation is truly associated with more aggressive papillary thyroid cancer.

THE FULL ARTICLE TITLE
Lai HF et al BRAF V600E mutation lacks association with poorer clinical prognosis in papillary thyroid carcinoma. Ann Surg Oncol. Epub 2024 Feb 1; doi: 10.1245/s10434- 024-14935-4. PMID: 38300401.

SUMMARY OF THE STUDY
The authors studied patients with papillary thyroid cancer treated at a single institute in Taipei, Taiwan. They reviewed the records of 672 patients (74.3% female) treated between 2013 and 2018. Among these patients, 76.8% had cancers that were positive for the BRAF V600E mutation. Then they examined whether cancers with the BRAF V600E mutation had a higher risk of local spread within the neck near the thyroid, spread to lymph nodes, spread to distant organs, and cancer recurrence. Unexpectedly, they found that cancers without the BRAF V600E mutation were associated with larger primary cancer size, distant spread, and more advanced stages. Recurrence rates (disease-free survival) were similar between patients with and without the BRAF V600E mutation.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In this study, cancers without the BRAF V600E mutation were found to be more aggressive. This makes us question the importance of testing for the BRAF V600E mutation in papillary thyroid cancer, since having this mutation doesn’t mean the cancer will be worse. More research is needed to understand this better.

— Phillip Segal, MD

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