Risk Factors for TERT Promoter Mutations with Papillary Thyroid Carcinoma Patients: A Meta-Analysis and Systematic Review

Abstract

Whether TERT promoter mutation is related to more aggressive clinicopathologic features and worse outcomes in papillary thyroid carcinoma patients (PTCs) is still variable and controversial. Our intention was to investigate the risk or prognostic factors that may additionally predict the TERT promoter mutation doable of these lesions and new prevention techniques in PTCs. A total of 2,539 PTC patients with 11.50% TERT mutation have been analyzed using Revman 5.3 software in this study. The PubMed and Embase databases were systematically searched for works published until November 9, 2021. The following variables had been associated with an extended chance of TERT promoter mutation in PTC patients: age < 45 years (MD = 10.93, 95%CI = 7.25-14.61); gender = male (pooled OR = 1.63, 95%CI = 1.17-2.28); tumor size > 1 cm (MD = 0.56, 95%CI = 0.34-0.77); lymph node metastasis (pooled OR = 1.29, 95%CI = 0.93-1.79); vascular invasion (pooled OR = 1.78, 95%CI = 0.83-3.84); extrathyroidal extension (pooled OR = 2.00, 95%CI = 1.32-3.02); distant metastasis (pooled OR = 1.46, 95%CI = 1.04-2.04); advanced TNM stage (pooled OR = 3.19, 95%CI = 2.28-4.45). In addition, multifocality (pooled OR = 0.67, 95%CI = 0.14-3.24) had no affiliation with TERT promoter mutation in PTC patients. Our finding showed that age < 45 years, male, tumor size > 1 cm, lymph node metastasis, vascular invasion, and superior/advanced TNM stage were dangerous elements for TERT promoter mutation of worse effect in PTCs while that multifocality was once negatively correlated. TERT promoter mutation is drastically associated with recurrence and PTC-related mortality.

Figure 1

Flowchart of the selection process on the study.

Figure 2

Forest plots of the relationship between age and TERT mutation in PTC patients.

Figure 3

Forest plots of the relationship between gender and TERT mutation in PTC patients.

Figure 4

Forest plots of the relationship between tumor size and TERT mutation in PTC patients.

Figure 5

Forest plots of the relationship between multifocality and TERT mutation in PTC patients.

Figure 6

Forest plots of the relationship between LNM and TERT mutation in PTC patients.

Figure 7

Forest plots of the relationship between capsular invasion and TERT mutation in PTC patients.

Figure 8

Forest plots of the relationship between ETE and TERT mutation in PTC patients.

Figure 9

Forest plots of the relationship between distant metastasis and TERT mutation in PTC patients.

Figure 10

Forest plots of the relationship between TNM stage and TERT mutation in PTC patients.

Figure 11

Funnel plots for publication bias analysis of the included articles. ^†The OR, MD with 95% CIs for the association between TERT mutation and age, gender, tumor size, multifocality, LNM, capsular invasion, ETE, distant metastasis, and TNM stage, respectively in patients with PTCs. ^‡M-H represents Mantel-Haenszel; ^§IV represents inverse variance.