A histo-clinical score to predict evolution to radioactive iodine-refractory of the follicular cell-derived thyroid carcinoma (PREDIRAIR): a single-centre, prospective, cohort study

Background: Radioiodine refractory (RAIR) non-anaplastic follicular-cells derived thyroid carcinomas (FCDTC), are responsible for most FCDTC mortality. Although early detection could enable personalised strategies, precise risk factors are largely unknown. We aimed to search for clinical and histopathological predictive factors available at diagnosis for RAIR evolution. Methods: In this single-centre cohort study, patients treated between 2009 and 2018 for a pT3, pT4 or M1 FCDTC (2010 TNM classification), were prospectively enrolled after thyroidectomy. Updated centralised histological review was performed, and a Cox model was used to explore time to RAIR disease. The final multivariable model was then transformed into a 16-point score. Findings: promoter mutation (3·22, 1·64-6·33; 3 points), and HG-TC (6·15, 2·86-13·21; 6 points). Interpretation: promoter mutation are the strongest predictive factors. Funding: Société Française d'Endocrinologie, Ligue Contre le Cancer.