Journal Article Epublish
PubMed: 41969334 DOI: 10.1016/j.eclinm.2026.103839
A histo-clinical score to predict evolution to radioactive iodine-refractory of the follicular cell-derived thyroid carcinoma (PREDIRAIR): a single-centre, prospective, cohort study.
EClinicalMedicine 94:103839
Authors: Laurine Mebarki, Elise Andre, Fabien Subtil, Claire Bournaud, Françoise Borson-Chazot, Jean-Christophe Lifante, Juliette Abeillon, Solène Castellnou, Françoise Descotes, Véronique Raverot, Mireille Bertholon-Gregoire, Mirela-Diana Ilie, Myriam Decaussin-Petrucci, Hélène Lasolle
Affiliations
- Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.
- Service d'Anatomo-Pathologie, Hospices Civils de Lyon, Lyon, France.
- Service de Biostatistique, Hospices Civils de Lyon, Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France.
- Service d'Endocrinologie et Diabétologie, CH de Roanne, Roanne, France.
- Lyon 1 University, France.
- Service de Chirurgie Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
- Service de Médecine Nucléaire, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.
- Service de Biochimie Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France.
- Service de Biologie et de Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.
- Centre de Recherche sur le Cancer de Lyon, INSERM1052 CNRS5286, Lyon, France.
- CRCL (Inserm U1052, CNRS U5286), France.
Abstract
BACKGROUND
Radioiodine refractory (RAIR) non-anaplastic follicular-cells derived thyroid carcinomas (FCDTC), are responsible for most FCDTC mortality. Although early detection could enable personalised strategies, precise risk factors are largely unknown. We aimed to search for clinical and histopathological predictive factors available at diagnosis for RAIR evolution.
METHODS
In this single-centre cohort study, patients treated between 2009 and 2018 for a pT3, pT4 or M1 FCDTC (2010 TNM classification), were prospectively enrolled after thyroidectomy. Updated centralised histological review was performed, and a Cox model was used to explore time to RAIR disease. The final multivariable model was then transformed into a 16-point score.
FINDINGS
Histopathological review identified 28 patients with low-risk neoplasms and 225 with FCDTC. The median follow-up for FCDTC was 8·3 years (95% CI 7·9-8·9), and 40 patients had RAIR- FCDTC (18%).Univariable analyses identified age ≥55 years, stimulated thyroglobulin ≥20 ng/mL at first radioiodine treatment, tumour size, TERT promoter mutation (not BRAF), un-encapsulated, adipose, muscle and vascular invasion, high Ki67 index, and high-grade follicular cell derived carcinomas (HG-TC) as associated with RAIR evolution at 5 years. On the basis of the final multivariable model with an AUC of 0·90 (0·82-0·97), a 16-point score was constructed: age ≥55 years (hazard ratio 2·05, 95% CI 1·01-4·16; 2 points), stimulated thyroglobulin ≥20 ng/mL at first RAI (5·20, 2·51-10·75; 5 points), TERT promoter mutation (3·22, 1·64-6·33; 3 points), and HG-TC (6·15, 2·86-13·21; 6 points).
INTERPRETATION
This score allows early identification of patients at risk of RAIR disease. Recent histological category of HG-TC and TERT promoter mutation are the strongest predictive factors.
FUNDING
Société Française d'Endocrinologie, Ligue Contre le Cancer.
MeSH
Cells, Promoter Regions, Genetic, Neoplasms, Cohort Studies, Thyroid Gland, Thyroglobulin, Mutation