{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:54:31Z","timestamp":1790747671455,"version":"4.1.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The clinical utility of postoperative radioiodine (\n                      <jats:sup>131<\/jats:sup>\n                      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\n                      <jats:sup>131<\/jats:sup>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A single-center retrospective cohort study enrolled 113 eligible patients, allocated to the\n                      <jats:sup>131<\/jats:sup>\n                      I ablation group (n=62) and non-\n                      <jats:sup>131<\/jats:sup>\n                      I group (n=51). Two-year dynamic risk stratification assessed treatment response. Kaplan\u2013Meier curves and Cox regression models were used for survival analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The predominant TERT-p variant was C228T (89.4%), and most patients carried concurrent BRAF\n                      <jats:sup>V600E<\/jats:sup>\n                      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 &amp;lt; 0.001). High baseline ATA risk was strongly correlated with structural residual lesions and unfavorable therapeutic response (p &amp;lt; 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 \u226555 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\n                      <jats:sup>131<\/jats:sup>\n                      I group and non-\n                      <jats:sup>131<\/jats:sup>\n                      I group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this retrospective observational cohort, postoperative\n                      <jats:sup>131<\/jats:sup>\n                      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\n                      <jats:sup>131<\/jats:sup>\n                      I efficacy. Clinically, routine\n                      <jats:sup>131<\/jats:sup>\n                      I yields no survival benefit for this high-risk molecular subgroup, guiding individualized surveillance and avoiding redundant\n                      <jats:sup>131<\/jats:sup>\n                      I exposure.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1895987","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:55:45Z","timestamp":1790744145000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations"],"prefix":"10.3389","volume":"16","author":[{"given":"Xian-Zhao","family":"Deng","sequence":"first","affiliation":[{"name":"Department of General Surgery, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Tian","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Jun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You-Ben","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan-yong","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-er","family":"Wei","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong-Ling","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, 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