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