<i>TERT</i> Promoter Mutation and Extent of Thyroidectomy in Patients with 1–4 cm Intrathyroidal Papillary Carcinoma

• Main Authors: Aya Ebina, Yuki Togashi, Satoko Baba, Yukiko Sato, Seiji Sakata, Masashi Ishikawa, Hiroki Mitani, Kengo Takeuchi, Iwao Sugitani
• Format: Article
• Language: English
• Published: MDPI AG 2020-07-01
• Series: Cancers
• Subjects: papillary thyroid carcinoma; <i>BRAF V600E</i>; <i>TERT</i> promoter mutations; lobectomy; total thyroidectomy
• Online Access: https://www.mdpi.com/2072-6694/12/8/2115

There are concerns regarding overtreatment in papillary thyroid carcinoma (PTC). <i>BRAF V600E</i> and <i>TERT</i> promoter mutations play important roles in the development of PTC. However, initial surgical approaches for PTC based on genetic characteristics remain unclear. The present study aimed to identify genetic mutations as predictors of prognosis and to establish proper indications for lobectomy (LT) in patients with 1–4 cm intrathyroidal PTC. Prospectively accumulated data from 685 consecutive patients with PTC who underwent primary thyroid surgery at the Cancer Institute Hospital, Tokyo, Japan, between 2001 and 2012 were retrospectively reviewed. Of the 685 patients examined, 538 (78.5%) had <i>BRAF V600E</i> mutation and 133 (19.4%) had <i>TERT</i> promoter mutations. Patients with <i>TERT</i> promoter mutations displayed significantly worse outcomes than those without mutations (10-year cause-specific survival (CSS): 73.7% vs 98.1%, <i>p </i>< 0.001; 10-year disease-free survival (DFS): 53.7% vs 93.3%, <i>p </i>< 0.001). As for extent of thyroidectomy among <i>TERT</i> mutation-negative patients with 1–4 cm intrathyroidal PTC, patients who underwent LT showed no significant differences in 10-year CSS and 10-year DFS compared to patients who had total thyroidectomy (TT) under propensity score-matching. Avoiding TT for those patients indicates a possible pathway to prevent overtreatment and reduce postoperative complications.