Patients with follicular and Hurthle cell microcarcinomas have compromised survival: a population level study of
Eric J Kuo1, Sanziana A Roman, Julie A Sosa
1Yale School of Medicine, New Haven, CT.
Background:
There is a scarcity of evidence regarding outcomes of patients with follicular thyroid microcarcinoma and Hurthle cell microcarcinoma (<1 cm); optimal treatment for these tumors remains unclear.
Methods:
Patients with follicular and Hurthle cell microcarcinomas, together (mFHCC), were selected from the Surveillance, Epidemiology, and End Results database (1988-2009) and compared with papillary thyroid microcarcinoma (mPTC). Data were analyzed with Chi-square tests, analysis of variance, the Kaplan-Meier method, log-rank tests, and Cox proportional hazards.
Results:
We identified 564 cases of mFHCC (371 mFTC and 193 mHCC) and 22,174 cases of mPTC. mFHCC had >8 times the rate of distant (extracervical) metastases compared with mPTC (4.1% vs. 0.5%; P < .001). The 10-year disease-specific survival rate was decreased in mFHCC compared with mPTC (95.4% vs. 99.3%; P < .001), and after adjustment, follicular or Hurthle cell histology remained an independent predictor of increased mortality (hazard ratio, 5.30; P < .001). There was no difference in survival for patients who underwent total thyroidectomy versus thyroid lobectomy.
Conclusion:
In comparison with mPTC, mFHCC is rare, presents more often with distant metastases, and patients have compromised survival. Additional studies are necessary in defining the extent of surgery and role of radioactive iodine for the treatment of mFHCC.
Insights
Follicular and Hurthle cell microcarcinomas (mFHCC) are rare and present with more metastases and worse survival than papillary thyroid microcarcinoma (mPTC). Treatment strategies require further study.
Area of Science:
- Endocrinology
- Oncology
- Surgical Pathology
Background:
- Limited evidence exists for follicular thyroid microcarcinoma and Hurthle cell microcarcinoma (<1 cm).
- Optimal treatment strategies for these rare thyroid cancers are not well-defined.
Purpose of the Study:
- To compare outcomes of follicular and Hurthle cell microcarcinomas (mFHCC) with papillary thyroid microcarcinoma (mPTC).
- To identify prognostic factors for mFHCC.
Main Methods:
- Retrospective analysis of the Surveillance, Epidemiology, and End Results database (1988-2009).
- Comparison of mFHCC (n=564) with mPTC (n=22,174).
- Statistical analysis included Chi-square, ANOVA, Kaplan-Meier, log-rank, and Cox proportional hazards models.
Main Results:
- mFHCC demonstrated a >8-fold higher rate of distant metastases compared to mPTC (4.1% vs. 0.5%).
- The 10-year disease-specific survival was significantly lower for mFHCC (95.4%) versus mPTC (99.3%).
- Follicular or Hurthle cell histology was an independent predictor of increased mortality (HR, 5.30). No survival difference was observed between total thyroidectomy and thyroid lobectomy.
Conclusions:
- Follicular and Hurthle cell microcarcinomas are rare, metastasize more frequently, and are associated with poorer survival compared to papillary thyroid microcarcinoma.
- Further research is needed to establish optimal surgical extent and the role of radioactive iodine therapy for mFHCC.
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