Developing Models to Predict V600E and Mutational Status in Papillary Thyroid Carcinoma Using Clinicopathological Features and pERK1/2 Immunohistochemistry Expression.

The Cancer Genome Atlas (TCGA) has classified papillary thyroid carcinoma (PTC) into indolent RAS-like and aggressive BRAF-like based on its distinct driver gene mutations. This retrospective study aimed to assess clinicopathology and pERK1/2 expression variations between BRAF-like and RAS-like PTCs and establish predictive models for V600E and -mutated PTCs. A total of 222 PTCs underwent immunohistochemistry staining to assess pERK1/2 expression and Sanger sequencing to analyze the and genes. Multivariate logistic regression was employed to develop prediction models. Independent predictors of the V600E mutation include a nuclear score of 3, the absence of capsules, an aggressive histology subtype, and pERK1/2 levels exceeding 10% (X = 0.128, > 0.05, AUC = 0.734, < 0.001). The mutation predictive model includes follicular histology subtype and pERK1/2 expression > 10% (X = 0.174, > 0.05, AUC = 0.8, < 0.001). We propose using the prediction model concurrently with four potential combination group outcomes. PTC cases included in a combination of the low-V600E-scoring group and high--scoring group are categorized as RAS-like (adjOR = 4.857, = 0.01, 95% CI = 1.470-16.049). PTCs included in a combination of the high-V600E-scoring group and low--scoring group are categorized as BRAF-like PTCs (adjOR = 3.091, = 0.001, 95% CI = 1.594-5.995). The different prediction models indicate variations in biological behavior between BRAF-like and RAS-like PTCs.