Endocrinol Metab > Volume 37(6); 2022 > Article
Park and Chung: Frequency of TERT Promoter Mutations in Real-World Analysis of 2,092 Thyroid Carcinoma Patients (Endocrinol Metab 2022;37:652-63, Heera Yang et al.)
We would like to thank Dr. Kim and colleagues for carefully reading our article and providing thoughtful comments regarding our recent publication, titled “Frequency of TERT promoter mutations in real-world analysis of 2,092 thyroid carcinoma patients” [1]. We reported that the frequency of real-world telomerase reverse transcriptase (TERT) promoter mutations in thyroid carcinoma was lower (3.4%) than in a previous report [2], and it was particularly low in papillary thyroid carcinoma (PTC) ≤1 cm (0.5%).
Previous studies have reported that TERT promoter mutations were significantly associated with poor prognoses, such as tumor aggressiveness, early recurrence, and cancer-specific death [3]. However, the real-world frequency of TERT promoter mutations was unclear before Kim et al. [4] first reported it in Korea in 2020. Furthermore, in a letter to the editor, Kim et al. [4] provided data from a meta-analysis, which constituted valuable findings that could help us understand TERT promoter mutations more precisely.
According to the meta-analysis data, the frequency of TERT promoter mutation in a prospective cohort in Korea was lower than expected (2.6% in all PTCs, 1.3% in PTCs ≤1.0 cm, and 5.6% in PTCs >1.0 cm). Although the real-world frequency was low, the clinicopathological characteristics associated with TERT promoter mutations, such as older age, larger size, and tumor aggressiveness, were consistent with the previous report [3]. We appreciate Kim et al. for providing interesting data.
Kim et al. [5] also pointed out that the role of TERT promoter mutations in PTCs ≤1 cm is unclear. We previously reported that TERT promoter mutations can be a molecular prognostic marker in thyroid carcinoma, but we agree that this may not be the case in PTCs ≤1 cm. Future studies with long-term follow-up would be needed to provide solid evidence.
We deeply appreciate the valuable comments of Dr. Kim and colleagues and their work that enriched the findings of our research.



No potential conflict of interest relevant to this article was reported.


1. Yang H, Park H, Ryu HJ, Heo J, Kim JS, Oh YL, et al. Frequency of TERT promoter mutations in real-world analysis of 2,092 thyroid carcinoma patients. Endocrinol Metab (Seoul) 2022;37:652-63.
2. Yang J, Gong Y, Yan S, Chen H, Qin S, Gong R. Association between TERT promoter mutations and clinical behaviors in differentiated thyroid carcinoma: a systematic review and meta-analysis. Endocrine 2020;67:44-57.
3. Kim TH, Kim YE, Ahn S, Kim JY, Ki CS, Oh YL, et al. TERT promoter mutations and long-term survival in patients with thyroid cancer. Endocr Relat Cancer 2016;23:813-23.
4. Kim SY, Kim T, Kim K, Bae JS, Kim JS, Jung CK. Highly prevalent BRAF V600E and low-frequency TERT promoter mutations underlie papillary thyroid carcinoma in Koreans. J Pathol Transl Med 2020;54:310-7.
5. Kim TH, Ki CS, Kim HS, Kim K, Choe JH, Kim JH, et al. Refining dynamic risk stratification and prognostic groups for differentiated thyroid cancer with TERT promoter mutations. J Clin Endocrinol Metab 2017;102:1757-64.

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