Hurthle cell carcinoma

Abstract

BACKGROUND: Hurthle cell carcinoma (HCC) is an uncommon and more aggressive thyroid cancer. To date, there is a paucity of data at a population level. In this study, demographic, clinical, and pathologic characteristics of HCC were investigated and compared with other types of differentiated thyroid cancers (ODTCs). The authors also evaluated disease‐specific survival and compliance with American Thyroid Association (ATA) management guidelines from 2009. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer. Data analyses were performed using chi‐square tests, analysis of variance, Kaplan‐Meier analysis, binary logistic regression, and Cox proportional hazards regression. RESULTS: In total, 3311 patients with HCC and 59,585 patients with ODTC were identified. Compared with ODTC, HCC was more common among men (31.1% vs 23.0% for ODTC; P < .001) and among older patients (mean age, 57.6 years vs 48.9 years for ODTC; P < .001). Patients with HCC presented with higher SEER disease stage (P < .001), and their tumors were larger (36.1 mm vs 20.2 mm for ODTC; P < .001). Fewer patients underwent total thyroidectomy (P = .028). Both overall and disease‐specific survival were lower for patients with HCC (P < .001), and neither improved over the last 2 decades (P = .689). After adjustment, age ≥45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio >3.0). Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged ≥65 years (odds ratio [OR], 1.43; P = .002) and among unmarried patients (OR, 1.29; P = .004). Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age ≥65 years (OR, 1.31; P = .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively; P < .001). CONCLUSIONS: HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines. Cancer 2013. © 2012 American Cancer Society.

Thyroid Hürthle cell tumors: research of potential markers of malignancy

“…HCT is quite rare among differentiated thyroid carcinoma and analysis on large scale is difficult even in large database as SEER [8,11,21]. In fact, biases due to interpretation of histological findings (HCT to be follicular tumor or follicular variant of papillary carcinoma) and manipulation of data may determine different results on the same searched outcomes, as well as demonstrated by three different US study performed on the same database [8,11,21]. In our study, age, sex and size of HCT were comparable to those observed in the literature [7-11, 21, 28-32].…”

“…Cytological study subsequent to fine needle biopsy can identify the presence of oncocytic tumor cells, but does not distinguish benign from malignant tumors even though 30 % of HCT are malignant [2,5,6]. In the current literature, Hürthle cell carcinoma (HCC) represents 3-7 % of all thyroid carcinomas [2,7,8]. HCC has a more aggressive behavior compared to the other differentiated thyroid cancer, with a reduced disease-specific survival rate [2,8,9].…”

“…The only two factors that help in the diagnosis of HCC within HCT are vascular and/or capsular invasion [2,[5][6][7]. HCC at diagnosis tends to be larger than Hürthle cell adenoma (HCA) [8][9][10][11]. Tumor size greater than or equal to 4 cm correlates with 80 % possibility of malignancy [2,10].…”

“…In the current literature, Hürthle cell carcinoma (HCC) represents 3-7 % of all thyroid carcinomas [2,7,8]. HCC has a more aggressive behavior compared to the other differentiated thyroid cancer, with a reduced disease-specific survival rate [2,8,9]. The only two factors that help in the diagnosis of HCC within HCT are vascular and/or capsular invasion [2,[5][6][7].…”

Thyroid Cancers: Considerations, Classifications, and Managements

“…Patients with minimally invasive carcinomas usually experience a beter prognosis [73]. Overall, older patients and those with larger tumor size, extrathyroidal extension, and not undergoing surgery have reduced survival [74]. A previous study indicated that in patients with widely invasive HCC, stages III-IV are independent risk factors for recurrence or death.…”