Characterizing thyroid carcinomas in the elderly: Histological subtypes and TERT promoter mutation analysis based on...

Area of Science:

• Oncology
• Genetics
• Geriatrics

Background:

• Thyroid cancer in the elderly (≥70 years) often presents aggressively, posing treatment challenges due to comorbidities.
• Understanding the molecular drivers of aggressive thyroid cancer in older adults is critical for effective management.

Purpose of the Study:

• To investigate the association between telomerase reverse transcriptase (TERT) promoter mutations and high-risk histological subtypes (poorly differentiated thyroid cancer [PDTC] and differentiated high-grade thyroid cancer [DHGTC]) in elderly patients.
• To correlate TERT mutations with clinicopathological features indicative of poor prognosis in this demographic.

Main Methods:

• Retrospective analysis of 293 elderly patients (≥70 years) who underwent thyroidectomy.
• Collection of clinicopathological data, including TNM and AJCC staging.
• Molecular analysis for TERT promoter mutations using pyrosequencing.

Main Results:

• TERT promoter mutations were found in 15.0% of cases and were significantly associated with PDTC/DHGTC subtypes.
• TERT-mutated tumors were larger, showed more advanced T stage, and had higher rates of lymph node metastasis and distant recurrence.
• TERT mutations correlated with increased mitotic activity and tumor necrosis, indicating aggressive behavior.

Conclusions:

• PDTC/DHGTC subtypes and TERT promoter mutations are relatively common in elderly patients with thyroid cancer.
• TERT mutations are strong predictors of aggressive tumor characteristics and poor prognosis in this high-risk group.
• Combined histological and molecular assessment, including TERT mutation status, can enhance prognostic accuracy for elderly thyroid cancer patients.