Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Systematic review and meta-analysis of the association between autoimmune thyroiditis and papillary thyroid cancer with BRAF mutation       (#269)

Sumathy Perampalam 1 2 3 , Katherine Wu 4 , Matti Gild 3 4 , Lyndal Tacon 3 4 , Martyn Bullock 3 4 , Roderick Clifton-Bligh 3 4
  1. The Canberra Hospital, Garran, ACT, Australia
  2. School of Medicine and Psychology, Australian National University, Garran, ACT, 2065
  3. Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
  4. Department of Endocrinology, Diabetes and Metabolism, Royal North Shore Hospital, St Leonards, NSW, 2605

Autoimmune thyroid disease (AITD) co-exists in 15-25% of papillary thyroid carcinoma (PTC), with likely favourable outcome (1,2). However, the association between PTC with AITD and PTC with BRAF mutation is unclear. We conducted a systematic review with meta-analysis to evaluate:

  • the association between PTC with BRAF mutation and PTC with AITD and
  • the risk of:
    1. central lymph node disease (CLND) in BRAF mutant PTC
    2. CLND in PTC with AITD.

 

We searched PubMed, Embase and Web of Science Core Collection for observational studies published from 2010 to June 2023 on adult PTC patients.  Studies with data on PTC subsets for presence and absence of BRAF mutation, AITD and CLND were included. For analysis, groups were categorised as “exposed”:(i) BRAF PTC with AITD; (ii a) CLND with BRAF PTC; (ii b) CLND with AITD; and as “control”:(i) BRAF PTC without AITD; (ii a) CLND without BRAF PTC; (ii b) CLND without AITD.

Out of 699 studies initially identified, screening resulted in 44 studies with total of 30 141 PTC patients, mean age of 44 years, 68.3% with BRAF mutant PTC and 24.7% with AITD. Summary statistics of 38 studies showed PTC with AITD had a lower odds of PTC with BRAF mutation with pooled log odds ratio (LOR) of - 0.55 (95% CI-0.69 to -0.41, p <0.001). However, there was significant heterogeneity with I2 of 74.1 % (df 37.0;p<0.001). 10 studies showed BRAF PTC was associated with increased risk of CLND with pooled LOR of 0.49 (95% CI 0.18 to 0.81;p=0.002). In the same studies, PTC with AITD resulted in lower risk of CLND with LOR of -0.45 (-0.69 to -0.22;p=0.002).

Thus, concurrent AITD in PTC has a negative association with BRAF mutation. Risk of CLND is lower in PTC with AITD compared with PTC with BRAF mutation.

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  1. 1. Ju-Han Lee et al The association between papillary thyroid carcinoma and histologically proven Hashimoto's thyroiditis: a meta-analysis Eur J Endocrinology; 2013 15;168 (3):343-9. 2. Moon, SJ et al; Associations between Hashimoto Thyroiditis and Clinical Outcomes of Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies, Endocrinol Metab 2018;33:473-484