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Radioactive iodine (RAI) refractoriness further complicates DTC management, leading to substantially reduced survival rates. In this study, we aimed to identify anexelekto (AXL) expression and\n                      <jats:italic>TERT<\/jats:italic>\n                      promoter mutation as potential predictors of RAI-refractory DTC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective analysis of 81 DTC patients who underwent thyroidectomy and received at least two courses of RAI therapy. After a median follow-up period of 30 months (range: 6\u201360 months), therapy response was categorized as nonrefractory or refractory. AXL expression and\n                      <jats:italic>TERT<\/jats:italic>\n                      promoter mutation were evaluated in all patients to discern any associations with the development of RAI refractoriness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall prevalence of refractory RAI in DTC patients was 44.4% (36\/81). AXL expression was high in 30\/36 patients (83.3%) with RAI-refractory DTC and negative\/low in 24\/45 patients (53.3%) with non-RAI-refractory DTC (OR adjusted: 44.98, CI 95%: 1.41-1439.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031).\n                      <jats:italic>TERT<\/jats:italic>\n                      promoter mutation occurred in 21\/36 (58.3%) RAI-refractory DTCs and in 2\/45 (4.4%) non-RAI-refractory DTCs (OR adjusted: 10.95, CI 95%: 1.06-112.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044). Despite similar age, sex, and histological type distributions between the RAI-refractory and non-RAI-refractory groups, significant differences in clinicopathological characteristics emerged. Multivariate analysis confirmed that aggressive subtype, elevated AXL expression, and\n                      <jats:italic>TERT<\/jats:italic>\n                      promoter mutation independently correlated with RAI-refractory status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our predictive model highlights the association of elevated AXL expression,\n                      <jats:italic>TERT<\/jats:italic>\n                      promoter mutation, and an aggressive tumour subtype with the risk of RAI refractoriness. This information has the potential to aid in making informed treatment decisions. Furthermore, AXL is a potential therapeutic target for RAI-refractory disease.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13000-025-01643-0","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T08:46:31Z","timestamp":1744793191000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The ability of anexelekto (AXL) expression and TERT promoter mutation to predict radioiodine-refractory differentiated thyroid carcinoma"],"prefix":"10.1186","volume":"20","author":[{"given":"Hasrayati","family":"Agustina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tutik Nur","family":"Ayni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohana","family":"Azhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwin Affandi","family":"Soeriadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethy Suryawathy","family":"Hernowo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"1","key":"1643_CR1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s13550-022-00917-8","volume":"12","author":"Y Liu","year":"2022","unstructured":"Liu Y, Wang Y, Zhang W. 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