Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations
4 affiliations
- 1Department of General Surgery, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , ,
- 2Department of Nuclear Medicine, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , ,
- 3Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , ,
- 4Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine , ,
Abstract
Background: The clinical utility of postoperative radioiodine ( ¹³¹ I) ablation remains unclear for patients with initially diagnosed non-distant metastatic papillary thyroid carcinoma (PTC) with harboring TERT promoter(TERT-p) mutations, it is unknown whether ¹³¹ I therapy reduces the risk of persistent or recurrent disease. This study investigated clinicopathological features, 2-year dynamic therapeutic responses and progression-free survival (PFS) in this specific patient cohort.
Methods: A single-center retrospective cohort study enrolled 113 eligible patients, allocated to the ¹³¹ I ablation group (n=62) and non- ¹³¹ I group (n=51). Two-year dynamic risk stratification assessed treatment response. Kaplan–Meier curves and Cox regression models were used for survival analysis.
Results: The predominant TERT-p variant was C228T (89.4%), and most patients carried concurrent BRAF V600E mutations. Only initial surgical approach remained an independent intergroup variable. Within 2 years, 46.0% achieved acceptable responses, associated with sex and primary surgery (p=0.036,p < 0.001). High baseline ATA risk was strongly correlated with structural residual lesions and unfavorable therapeutic response (p < 0.001).No significant between-group differences in response were observed across all ATA risk subgroups. The median follow-up was 4.6 years; 3- and 5-year PFS rates were 67.5% and 39.1%. Age ≥55 years, N1b stage and high baseline ATA risk were independent adverse predictors of PFS. Both 2-year therapeutic response and PFS at the end of follow-up exhibited no statistical differences between the ¹³¹ I group and non- ¹³¹ I group.
Conclusions: In this retrospective observational cohort, postoperative ¹³¹ I ablation was not associated with improved PFS among patients with non-distant metastatic TERT-p-mutant PTC. Advanced age, N1b lymphatic metastasis and high baseline ATA risk independently predict poor outcomes. Biologically, TERT-p mutations induce tumor dedifferentiation and impaired iodine uptake, diminishing ¹³¹ I efficacy. Clinically, routine ¹³¹ I yields no survival benefit for this high-risk molecular subgroup, guiding individualized surveillance and avoiding redundant ¹³¹ I exposure.
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BibTeX
@article{deng2026twoyear,
title = {{Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations}},
author = {Xian-Zhao Deng and Meng-yue Liu and Chen-Tian Shen and Hong-Jun Song and Jian Wang and You-Ben Fan and Quan-yong Luo and Juan Tang and Xiao-er Wei and Zhong-Ling Qiu},
journal = {Frontiers in oncology},
year = {2026},
month = sep,
doi = {10.3389/fonc.2026.1895987},
url = {https://europepmc.org/article/PMC/PMC13661339},
note = {CC BY},
}
RIS
TY - JOUR
TI - Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations
AU - Xian-Zhao Deng
AU - Meng-yue Liu
AU - Chen-Tian Shen
AU - Hong-Jun Song
AU - Jian Wang
AU - You-Ben Fan
AU - Quan-yong Luo
AU - Juan Tang
AU - Xiao-er Wei
AU - Zhong-Ling Qiu
PY - 2026
DA - 2026/09/30
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1895987
UR - https://europepmc.org/article/PMC/PMC13661339
AB - Background: The clinical utility of postoperative radioiodine ( ¹³¹ I) ablation remains unclear for patients with initially diagnosed non-distant metastatic papillary thyroid carcinoma (PTC) with harboring TERT promoter(TERT-p) mutations, it is unknown whether ¹³¹ I therapy reduces the risk of persistent or recurrent disease. This study investigated clinicopathological features, 2-year dynamic therapeutic responses and progression-free survival (PFS) in this specific patient cohort. Methods: A single-center retrospective cohort study enrolled 113 eligible patients, allocated to the ¹³¹ I ablation group (n=62) and non- ¹³¹ I group (n=51). Two-year dynamic risk stratification assessed treatment response. Kaplan–Meier curves and Cox regression models were used for survival analysis. Results: The predominant TERT-p variant was C228T (89.4%), and most patients carried concurrent BRAF V600E mutations. Only initial surgical approach remained an independent intergroup variable. Within 2 years, 46.0% achieved acceptable responses, associated with sex and primary surgery (p=0.036,p < 0.001). High baseline ATA risk was strongly correlated with structural residual lesions and unfavorable therapeutic response (p < 0.001).No significant between-group differences in response were observed across all ATA risk subgroups. The median follow-up was 4.6 years; 3- and 5-year PFS rates were 67.5% and 39.1%. Age ≥55 years, N1b stage and high baseline ATA risk were independent adverse predictors of PFS. Both 2-year therapeutic response and PFS at the end of follow-up exhibited no statistical differences between the ¹³¹ I group and non- ¹³¹ I group. Conclusions: In this retrospective observational cohort, postoperative ¹³¹ I ablation was not associated with improved PFS among patients with non-distant metastatic TERT-p-mutant PTC. Advanced age, N1b lymphatic metastasis and high baseline ATA risk independently predict poor outcomes. Biologically, TERT-p mutations induce tumor dedifferentiation and impaired iodine uptake, diminishing ¹³¹ I efficacy. Clinically, routine ¹³¹ I yields no survival benefit for this high-risk molecular subgroup, guiding individualized surveillance and avoiding redundant ¹³¹ I exposure.
SN - 2234-943X
ER -