TERT Promoter Mutation And Its Association With The Prognosis Of Papillary Thyroid Cancer: A Meta-analysis

Objective: The effects of telomerase reverse transcriptase(TERT) promoter mutations on prognostic characteristics and clinical outcomes in papillary thyroid carcinoma(PTC)remain controversial. We performed a meta-analysis to elucidate the association between the prognostic factors of PTC and TERT promoter mutations.Method: A literature search was performed within Pub Med and EMBASE databases using the following Medical Subject Headings(Me SH) and keywords: “TERT,” “ telomerase reverse transcriptase” “mutation,” “thyroid,” “neoplasm(s),” “tumor,” “cancer,” and“carcinoma.” We used Rev Man(version 5) to calculate the summary odds ratios(ORs)with 95% confidence intervals(CIs), using a random-effects model when P value(chi-square test of homogeneity) < 0.1 and a fixed-effects model when P value(chi-square test of homogeneity) ≥ 0.1. Significant heterogeneity was defined as a chi-square test P value of < 0.10 or as an I2 measure > 50%.Results: The average prevalence rate of TERT mutations was 10.1%. TERT mutations occurred more frequently in larger tumors(p = 0.003). Compared with wild-type TERT,TERT mutations were associated with advanced stage(OR =3.11, 95% CI: 2.22–4.36),lymph node metastasis(OR = 1.82, 95% CI: 1.12–2.96), distant metastasis(OR = 4.18,95% CI: 1.61–10.81), positive BRAF mutation(OR = 2.71, 95% CI: 1.45–3.24), recurrence( OR = 3.91, 95% CI: 1.83–8.34), and mortality(OR = 8.13, 95% CI: 3.77–17.53). The associations of TERT mutations with extrathyroidal invasion(OR = 1.98, 95% CI:0.96–4.07),unifocality(OR = 1.36, 95% CI: 0.90–2.07) and vascular invasion(OR = 1.45,95% CI: 0.92–2.30) were not significant.Conclusion: TERT mutations are closely associated with aggressive clinicopathological characteristics and poorer prognosis in PTC.