Prognostic significance of clinicopathological and ultrasonographic features in anaplastic thyroid carcinoma beyond TERT promoter mutation

TERT promoter mutation is associated with poor prognosis in differentiated thyroid carcinoma, with US features varying by mutation status. However, this correlation in anaplastic thyroid carcinoma (ATC) is understudied. We investigated the association between clinicopathological characteristics and US features of ATC with TERT mutation status and prognosis. From November 1994 to May 2022, 58 ATC nodules from 58 patients were analyzed. Two radiologists retrospectively reviewed US features based on the revised K-TIRADS and ACR-TIRADS. Of all 58 ATC nodules, 32 nodules were tested for TERT promoter mutation and detected in 11. TERT promoter-mutated ATC was larger than TERT wild-type ATC (p = 0.032); however, no other differences were observed. ATC with survival period of less than 12 months were more likely to have lymph node metastasis (p = 0.012) or distant metastasis at diagnosis (p < 0.001), larger size on US (p = 0.005), and suspicion for gross extrathyroidal extension on US (p = 0.04) compared to ATC with survival period of 12 months or more. Advanced disease at diagnosis was a critical factor associated with 1-year survival in patients with ATC, whereas the TERT promoter mutation status was not.