Clinical and Molecular Predictors of Malignancy in a Series of 585 RAS-positive Thyroid Nodules with Surgical Outcome
Authors' conclusion
In this large series of RAS-positive tumors molecular and clinical factors predicted cancer. In isolated RAS-positive tumors, the rate of recurrent/persistent disease was very low with low rates of significant growth in non-resected nodules, suggesting that these nodules may be managed with lobectomy, and in select cases, even non-surgically.
Study context
- Population
- RAS-positive thyroid nodules detected using ThyroSeqv3 with either histopathology or ≥1 year follow-up ultrasound (2018–2024)RAS positive nodules with surgical pathology, 55 non-resected nodules also identified · RAS positive nodules with surgical pathology 585 · non-resected nodules 55
- Participants
- 585 participants
- Exposure
- Clinical and molecular predictors of malignancy or NIFTP in RAS-positive thyroid nodules
- Outcome
- Surgical pathology
- Follow-up
- After surgery
Main finding
As reported in the abstract
Benign
140 of 585
24%
NIFTP
149 of 585
25%
Cancer
296 of 585
51%
Observational data: associations, not effects.
Further findings
Rate of cancer/NIFTP — isolated KRAS vs isolated NRAS or HRAS · lower with isolated KRAS
P < 0.0001
Association with cancer/NIFTP
| OR | P value | |
|---|---|---|
| Presence of copy number alterations (CNA)Multivariable analysis | 12 | P = 0.02 |
| Nodule size on ultrasoundMultivariable analysis | 1.3 | P = 0.003 |
| Outcome | P value |
|---|---|
| Persistent/recurrent disease among patients with a cancer diagnosis · median follow-up of 2.5 years (IQR 1.2-4)Concurrent high-risk mutations vs without · more likely with concurrent high-risk mutations | P < 0.0001 |
- Persistent/recurrent disease among patients with a cancer diagnosis — persistent/recurrent disease, patients with a cancer diagnosis
- 19/272 (7%)
- Persistent/recurrent disease among patients with a cancer diagnosis — isolated RAS cancers
- 1/133, 0.8%
- Persistent/recurrent disease among patients with a cancer diagnosis: concurrent high-risk mutations 50%
- Persistent/recurrent disease among patients with a cancer diagnosis: without concurrent high-risk mutations 2%
Association with cancer/NIFTP
- Higher Bethesda classification (IV, V or VI) associated with cancer/NIFTP
Significant growth in non-resected nodules · median 2.3 years (IQR 1.5-4.5)
- Nodules with significant growth
- 6/55 nodules (11%)
Original publication
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