Clinicopathological and Molecular Predictors of Recurrence in Adolescents and Young Adults with Papillary Thyroid Carcinoma: A Central Asian Cohort Study

Background/Objectives: Although papillary thyroid carcinoma generally has an excellent prognosis, recurrence remains an important clinical problem in adolescents and young adults (AYA), while the prognostic value of molecular markers in this population is still unclear. This study aimed to identify clinicopathological and molecular predictors of recurrence in young patients with papillary thyroid carcinoma from Kazakhstan. Methods: This retrospective multicenter study included 246 consecutive patients with histologically confirmed papillary thyroid carcinoma. Tumor specimens collected between 2016 and 2020 were obtained from three tertiary oncology centers in Kazakhstan. Results: In the AYA subgroup, none of the evaluated clinicopathological or molecular variables was significantly associated with recurrence after multivariable adjustment. TERT promoter-related alterations showed the largest estimated association with recurrence, with an odds ratio (OR) of 9.05 (95% confidence interval [CI], 1.00–59.86; p = 0.333), while lymph node metastasis demonstrated the strongest trend toward poorer progression-free survival in the overall cohort, with a hazard ratio (HR) of 9.61 (95% CI, 0.92–100.49; p = 0.059); no significant predictors of overall survival were identified. Conclusions: Recurrence risk among adolescents and young adults with papillary thyroid carcinoma is heterogeneous and may be more accurately assessed by combining conventional clinicopathological factors with molecular markers, particularly TERT promoter mutation status. These findings support a more personalized approach to postoperative surveillance and precision management of young patients in Central Asia.