Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy
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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.
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.
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.
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.
KeywordsPapillary thyroid cancer Oncocytic Oxyphilic papillary thyroid cancer Hürthle cell carcinoma Thyroid gland
Parts of this paper originate from Annamirl Jellinek’s doctoral thesis.
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
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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