Effect of Having Concurrent Mutations on the Degree of Aggressiveness in Patients with Thyroid Cancer Positive for Promoter Mutations.

This study aimed to examine whether concurrent mutations with a promoter mutation are associated with a greater likelihood of more aggressive disease than a promoter mutation alone. The medical records of 1477 patients who underwent thyroid surgery at two tertiary hospitals between 2017 and 2022 were reviewed. Twenty-four patients had promoter mutations based on molecular profile testing. Clinicodemographic data, mutational profiles, and histopathological features were assessed. Descriptive analysis, Fisher's exact test, and binary logistic regression were performed. Seven patients had single-gene promoter mutations, and 17 had concurrent mutations, including , , , , and . The overall prevalence of malignancy was 95.8%, of which 78.3% were aggressive thyroid cancers. There was a statistically significant association between concurrent mutations and disease aggressiveness. The odds of having aggressive disease were 10 times higher in patients with a promoter mutation and a concurrent molecular alteration than in those with a promoter mutation alone. This is an important finding for thyroid specialists to consider when counseling patients concerning risk stratification and management options.