Table 2_Two-year dynamic risk stratification and adjuvant radioiodine efficacy in initial non-distant metastatic papillary thyroid carcinoma harboring TERT promoter mutations.docx

Within 2 years, 46.0% achieved acceptable responses, associated with sex and primary surgery (p=0.036,p < 0.001). High baseline ATA risk was strongly correlated with structural residual lesions and unfavorable therapeutic response (p < 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 ≥55 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 ¹³¹I group and non-¹³¹I group.</p>Conclusions<p>In this retrospective observational cohort, postoperative ¹³¹I 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 ¹³¹I efficacy. Clinically, routine ¹³¹I yields no survival benefit for this high-risk molecular subgroup, guiding individualized surveillance and avoiding redundant ¹³¹I exposure.</p>