Predictive Factors for Distant Metastasis in Follicular Thyroid Carcinoma: Analysis of Clinical, Genetic, and Radiomics Features

Purpose Distant metastasis in follicular thyroid carcinoma (FTC) significantly affects prognosis and treatment strategies.This study aimed to identify the most effective predictors of distant metastasis in patients with FTC. Materials and MethodsWe conducted a retrospective analysis of 105 FTC cases (8 with distant metastasis and 97 without) from 1997 to 2018 at a single tertiary hospital.We analyzed the clinicopathological characteristics, genetic markers (RAS and telomerase reverse transcriptase [TERT] promoter mutations), and various US features.Radiomics features were extracted from the US images and assessed using five classifier models.Variables with p < 0.20 in univariable analysis were entered into the multivariable logistic regression model. ResultsThe metastasis group showed significant age differences (61.1 ± 12.2 vs. 43.8± 13.5 years, p = 0.001), tumor volume (44.7 ± 42.7 cm³ vs. 15.9 ± 29.8 cm 3 , p = 0.013), and maximal size (5.1 ± 2.1 cm vs. 3.5 ± 1.9 cm, p = 0.020).The genetic analysis revealed significantly higher rates of TERT and RAS mutations in the metastatic group (75.0%, 6/8 patients) compared to the non-metastatic group (3.1%, 3/97 patients) (p < 0.001).Radiomics texture analysis demonstrated poor predictive performance (mean area under the receiver operating characteristic curve, 0.53).In multivariate analysis, age (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.00-1.20,p = 0.040) and TERT and RAS co-mutations (OR = 52.1,95% CI = 7.21-822.5,p < 0.001) remained independent predictors.Tumor size was not significant in multivariate analysis. Conclusion Advanced age patients with FTC and positive TERT and RAS mutations require