Are TERT promoter mutations a poor prognostic factor in anaplastic thyroid carcinoma?

Abstract

Purpose Telomerase reverse transcriptase (TERT) promoter mutations are a poor prognostic factor in differentiated thyroid carcinoma (DTC). However, their prognostic value in anaplastic thyroid carcinoma (ATC) is unclear. Therefore, we investigated whether TERT promoter mutations also act as an independent poor prognostic factor in ATC. Methods We reviewed the medical records of 28 patients with ATC who underwent the TERT promoter mutations test at Samsung Medical Center between November 1995 and May 2020. The aggressive treatment group was defined as patients who underwent surgery, external radiotherapy, and systemic therapy. Results Among 28 patients, TERT promoter mutations were found in 10 patients (35.7%). There were no differences in the clinicopathological characteristics between the TERT-mutant and wild-type groups except tumor size and treatment modality. Median tumor size in the TERT-mutant group was 5.9 cm (3.7–11.0), which was significantly larger than that in the wild-type group (4.2 cm, 0.8–6.8, P = 0.006). Aggressive treatment was performed more frequently in the TERT-mutant group (60.0% vs. 22.2%, P = 0.046). The median overall survival (OS) was 6.9 months (0.4–39.5). The OS of the TERT-mutant group was longer that of than the wild-type group, but the difference was not significant (9.1 months [0.4–39.5] vs. 6.1 months [0.4–39.0], P = 0.432). In multiple regression analysis, old age (≥ 68.5 years), lymph node metastasis, and distant metastasis were significant prognostic factors, but TERT promoter mutations were not. Conclusion Unlike DTC, TERT promoter mutations were not an independent poor prognostic factor in ATC.