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Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Oncocytic (Hürthle cell) papillary thyroid carcinoma (OPTC) is a rare variant of the papillary thyroid carcinoma (PTC) which comprises approximately 1 to 11 % of PTC cases. Its clinical course and prognosis have not been comprehensively documented and the clinical outcome remains a controversial issue. Therefore, we investigated the long-term prognosis after thyroidectomy and (adjuvant) initial radioactive iodine therapy (RIT) of OPTC compared to PTC.

Methods

A total of 563 patients (47 with OPTC and 516 with PTC) with a median follow-up of 9.9 (0.3; 23.5) years were studied. All patients underwent thyroidectomy followed by (adjuvant) initial RIT. Data on the patients’ demographics, pathology, laboratory findings, imaging studies, treatment, and follow-up including recurrence, and disease-specific survival were collected. Cox’s multivariate regression model was used to identify independent prognostic factors for survival.

Results

OPTC patients were significantly older (55.2 ± 12.3 years) than PTC patients (50.3 ± 13.5) at the time of initial diagnosis (p value 0.016). Initial tumor size was larger in the OPTC group (2.8 ± 1.8 cm for OPTC patients, 1.5 ± 1.2 cm for PTC patients, p value < 0.001). Before matching, OPTC patients presented more often with evidence of disease at the last visit of follow-up (p value 0.046). However, this difference was not observed anymore after matching for risk factors (p value 0.637). Disease-specific survival did not differ significantly. Age (HR, 1.183; 95% CI, 1.097–1.276) was identified as an independent prognostic factor for disease-specific survival. OPTC patients predominantly showed a recurrence of distant metastasis within a shorter time despite being not statistically significant.

Conclusion

At initial diagnosis, OPTC shows significant differences in terms of age and initial tumor size compared to PTC. Patients suffering from OPTC present with the same clinical long-term outcome indifferent to PTC after (adjuvant) initial RIT after matching.

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Acknowledgments

Parts of this paper originate from Annamirl Jellinek’s doctoral thesis.

Funding

This work was financially supported by the Kuhbier-Langewiesche foundation. Vera Wenter was financially supported by the Bavarian Equal Opportunities Sponsorship (BGF) to promote equal opportunities for women in research and teaching. The sponsorship did not influence study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Harun Ilhan and Andrei Todica contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany

    Vera Wenter, Annamirl Jellinek, Marcus Unterrainer, Freba Ahmaddy, Sebastian Lehner, Nathalie Lisa Albert, Peter Bartenstein, Harun Ilhan & Andrei Todica

  2. Ambulatory Healthcare Center Dr. Neumaier & Colleagues, Radiology, Nuclear Medicine, Radiation Therapy, Regensburg, Germany

    Sebastian Lehner

  3. Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany

    Peter Bartenstein, Christine Spitzweg, Harun Ilhan & Andrei Todica

  4. Institute of Pathology, Faculty of Medicine, University Hospital, LMU Munich, Munich, Germany

    Thomas Knösel

  5. Department of Internal Medicine IV, University Hospital, LMU Munich, Munich, Germany

    Thomas Knösel & Christine Spitzweg

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  1. Vera Wenter
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Correspondence to Vera Wenter or Andrei Todica.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was authorized by the local ethics committee (Ethics committee of the Medical Faculty, University Hospital, LMU Munich, Munich, Germany, IRB 18-768) in accordance with the ICH Guideline for Good Clinical Practice (GCP) and the Declaration of Helsinki.

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The requirement to obtain informed consent was waived by the local ethics committee due to the retrospective design of this study.

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Wenter, V., Jellinek, A., Unterrainer, M. et al. Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy. Eur J Nucl Med Mol Imaging 46, 2526–2535 (2019). https://doi.org/10.1007/s00259-019-04456-8

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