Work

Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations

Year: 2026

Type: article

Abstract: Background In patients with non-distant metastatic PTC and TERT-p mutation being a rare entity at initial diagnosis, it is unclear whether 131I treatment is effective and can reduce the risk of recurrence after surgery. The objective of this study was to determine the clinical characteristics, effectiveness of radioiodine (131I), and recurrence-free survival (RFS) in patients with non-distant metastatic papillary thyroid cancer (PTC) and TERT-p mutation at initial diagnosis. Patients and Methods A retrospective observational review of clinical data collected between January 2016 and December 2023. One hundred and thirteen patients with non-distant metastatic PTC and TERT-p mutation at initial diagnosis were included.Therapeutic efficacy was evaluated using the dynamic risk stratification. Recurrence-free survival (RFS) was assessed using the Kaplan-Meier method and a Cox proportional hazards model. Results: One hundred and thirteen patients were were included.Sixty-two patients (54.9%) received postoperative 131I and 51 (45.1%) did not. There was a significant association between the American Thyroid Association (ATA) risk stratification and whether or not there was an acceptable response at the end of follow-up (p=0.001). There were significant associations of structural disease and TERT-p mutation with extra-thyroidal extension (p=0.003) and ATA risk stratification (p<0.001). Multivariate analyses indicated that age ≥55 years at initial diagnosis, N1b stage, and high-risk stratification were independent prognostic factors for RFS (p=0.014, p=0.003, and p=0.045, respectively). Conclusions: 131I treatment may have no effect on RFS in patients with non-distant metastatic PTC and TERT-p mutation at initial diagnosis.

Source: Frontiers in Oncology

DOI: 10.3389/fonc.2026.1895987