BRAFV600Etesting for low-risk papillary thyroid microcarcinomas – Computational model from a patient-oriented approach
Abstract
Background: Given the good prognosis of low-risk papillary thyroid microcarcinomas (lrPTMCs) accurate risk stratification is valuable to optimize management: active surveillance (AS) vs. hemithyroidectomy (HT). BRAFV600E testing was associated with increased recurrence risk, hence AS was suggested for mutation-negative lrPTMC. However, when considering AS, patient perception is highly important as adherence and emotional aspects are challenging. In this study, we aimed to model the contribution ofBRAFV600E testing for the management of PTMCs when tailored to the patient perspective.
Methods: We developed a Markovian model to predict the role ofBRAFV600E in prioritizing between HT and AS for lrPTMCs. We used a simulated cohort of lrPTMCs, with probabilities of each strategy driven from previous literature. Outcomes were measured as quality-of-life years (QALYs). One- and two-way sensitivity analyses were conducted to ascertain model robustness.
Results: We found that the optimal strategy (e.g., that would maximize QALYs) varies according to BRAFV600Estatus for patients without a preset predilection between AS to HT. Using one-way sensitivity analysis, we found that the two main variables that have the strongest impact on the decision are the utility of AS and the utility of a disease-free state after HT. Two-way sensitivity analysis demonstrated that BRAFV600E status can define the optimal strategy for patients in the middle zone of the utility range (e.g., patients without clear preference).
Conclusions: Our model suggests thatBRAFV600E status can facilitate decision-making regarding AS vs. HT for patients without preset predilection. Our model supports further real-life studies of BRAFV600Etesting for PTMCs.
Keywords: thyroid cancer; microcarcinoma; molecular testing; molecular diagnostic; thyroid surgery; active surveillance