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

Wenter, Vera; Jellinek, Annamirl; Ahmaddy, Freba; Lehner, S.; Albert, Nathalie L.; Bartenstein, Peter; Knösel, Thomas; Spitzweg, Christine; Ilhan, Harun; Todica, Andrei

doi:10.1007/s00259-019-04456-8

Cited by 15 publications

(6 citation statements)

References 31 publications

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“…In some cohorts, patients with oncocytic PTC had more frequent locally invasive growth, extra-thyroidal extension and lymph node metastasis ( 1 , 10 , 14 ). In general, however, oncocytic PTCs were not significantly different from their matched non-oncocytic counterparts with respect to long-term outcome ( 7 , 12 ). In one clinical series, oncocytic PTCs were not significantly different from oncocytic/Hürthle cell thyroid carcinomas with respect to their overall clinicopathologic variables and favourable RAI response ( 10 ).…”

Section: Introductionmentioning

confidence: 70%

“…A wide range of outcomes has been reported for patients with oncocytic PTC, likely secondary to the lack of distinction between various types of oncocytic PTC and heterogenous grouping into “Hürthle cell” thyroid carcinomas. Some authors report that patients with oncocytic PTCs generally have an excellent prognosis with reported 5- and 10-year disease-free survival of 93% and 81%, respectively, and less than 10% of patients developing local or distant recurrence ( 7 , 14 ). Similar results were seen in our study with a cumulative incidence of any recurrence (local, regional, or distant) at 10 years of 8.0% (95%CI: 3.9-14.1%).…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that only 10% to 38% of oncocytic thyroid carcinomas take up RAI; resultantly, the use of RAI in this population has been inconsistent ( 3 , 4 ). Recent evidence suggests that RAI may improve overall survival (OS) in patients with differentiated oncocytic follicular cell thyroid carcinomas ( 5 – 7 ) whereas others argue that there is no evidence to support its use ( 5 , 8 , 9 ). Review of data on “Hürthle cell” carcinomas in the National Cancer Data Base from 1998 to 2006 identified that the use of RAI improved survival at 10 years from 65.0% to 74.4% (p<0.001) ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the published data do not meticulously distinguish the various types of oncocytic thyroid cancers including follicular variant and classical papillary thyroid carcinomas (PTCs), follicular thyroid carcinoma (oncocytic/Hürthle cell thyroid carcinoma), and poorly differentiated thyroid carcinomas (PDTCs) ( 11 ). The scant data on clinicopathologic characteristics of oncocytic PTCs stem from small clinical series ( 1 , 7 , 10 , 12 – 14 ). In some cohorts, patients with oncocytic PTC had more frequent locally invasive growth, extra-thyroidal extension and lymph node metastasis ( 1 , 10 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Oncocytic Papillary Thyroid Carcinoma and Oncocytic Poorly Differentiated Thyroid Carcinoma: Clinical Features, Uptake, and Response to Radioactive Iodine Therapy, and Outcome

et al. 2021

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ObjectiveThe main objective of this study was to review the clinicopathologic characteristics and outcome of patients with oncocytic papillary thyroid carcinoma (PTC) and oncocytic poorly differentiated thyroid carcinoma (PDTC). The secondary objective was to evaluate the prevalence and outcomes of RAI use in this population.MethodsPatients with oncocytic PTC and PDTC who were treated at a quaternary cancer centre between 2002 and 2017 were retrospectively identified from an institutional database. All patients had an expert pathology review to ensure consistent reporting and definition. The cumulative incidence function was used to analyse locoregional failure (LRF) and distant metastasis (DM) rates. Univariable analysis (UVA) was used to assess clinical predictors of outcome.ResultsIn total, 263 patients were included (PTC [n=218], PDTC [n=45]) with a median follow up of 4.4 years (range: 0 = 26.7 years). Patients with oncocytic PTC had a 5/10-year incidence of LRF and DM, respectively, of 2.7%/5.6% and 3.4%/4.5%. On UVA, there was an increased risk of DM in PTC tumors with widely invasive growth (HR 17.1; p<0.001), extra-thyroidal extension (HR 24.95; p<0.001), angioinvasion (HR 32.58; p=0.002), focal dedifferentiation (HR 19.57, p<0.001), and focal hobnail cell change (HR 8.67, p=0.042). There was additionally an increased risk of DM seen in male PTC patients (HR 5.5, p=0.03).The use of RAI was more common in patients with larger tumors, angioinvasion, and widely invasive disease. RAI was also used in the management of DM and 43% of patients with oncocytic PTC had RAI-avid metastatic disease. Patients with oncocytic PDTC had a higher rate of 5/10-year incidence of LRF and DM (21.4%/45.4%; 11.4%/40.4%, respectively). Patients with extra-thyroidal extension had an increased risk of DM (HR 5.52, p=0.023) as did those with angioinvasion. Of the patients with oncocytic PDTC who received RAI for the treatment of DM, 40% had RAI-avid disease.ConclusionWe present a large homogenous cohort of patients with oncocytic PTC and PDTC, with consistent pathologic reporting and definition. Patients with oncocytic PTC have excellent clinical outcomes and similar risk factors for recurrence as their non-oncocytic counterparts (angioinvasion, large tumor size, extra-thyroidal extension, and focal dedifferentiation). Compared with oncocytic PTCs, the adverse biology of oncocytic PDTCs is supported with increased frequency of DM and lower uptake of RAI.

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Section: Introductionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oncocytic Papillary Thyroid Carcinoma and Oncocytic Poorly Differentiated Thyroid Carcinoma: Clinical Features, Uptake, and Response to Radioactive Iodine Therapy, and Outcome

et al. 2021

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“…Patient outcomes were compared at four different time points: 1st control after RIT, during follow-up, last visit of follow-up, and end of study in analogy of a previously published study [27]: In the 1st control, patients were categorized into two groups, namely NED and ED. NED was assumed if Tg level was under the detection limit (1.6 ng/ml 1993-1996; < 1.0 ng/ml 1996-1997, < 0.5 ng/ml after 1998) while Tg recovery was in normal range.…”

Section: Definition Of Endpointsmentioning

confidence: 99%

Clinical impact of follicular oncocytic (Hürthle cell) carcinoma in comparison with corresponding classical follicular thyroid carcinoma

Wenter

Albert

Ahmaddy

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose There are controversial debates if patients with Hürthle cell carcinoma, also known as oxyphilic or oncocytic cell follicular thyroid carcinoma, have a poorer outcome. In this study, we systematically evaluated the clinical outcome in a large patient cohort following thyroidectomy and initial I-131 radioactive iodine therapy (RIT). Methods We retrospectively evaluated a total of 378 patients with diagnosed oncocytic follicular Hürthle cell carcinoma (OFTC) (N = 126) or with classical follicular thyroid carcinoma (FTC) (N = 252). Patients received thyroidectomy and complementary I-131 RIT. Clinical data regarding basic demographic characteristics, tumor grade, persistent disease and recurrence during followup, and disease-free, disease-specific, and overall survival were collected during follow-up of 6.9 years (interquartile range 3.7; 11.7 years). Univariate and multivariate analyses were used to identify factors associated with disease-related and overall survival. Results Before and after matching for risk factors, recurrence was significantly more frequently diagnosed in OFTC patients during follow-up (17% vs. 8%; p value 0.037). Likewise, OFTC patients presented with a reduced mean disease-free survival of 17.9 years (95% CI 16.0-19.8) vs. 20.1 years (95% CI 19.0-21.1) in FTC patients (p value 0.027). Multivariate analysis revealed OFTC (HR 0.502; 95% CI 0.309-0.816) as the only independent prognostic factor for disease-free survival. Distant metastases of OFTC patients were significantly less iodine-avid (p value 0.014). Mean disease-specific and overall survival did not differ significantly (p value 0.671 and 0.687) during follow-up of median 6.9 years (3.7; 11.7 years). Conclusions Our study suggests that recurrence is more often seen in OFTC patients. OFTC patients have a poorer prognosis for disease-free survival. Thus, OFTC and FTC behave differently and should be categorized separately. However, patients suffering from OFTC present with the same overall and disease-specific survival at the end of follow-up indifferent to FTC patients after initial RIT.

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Radioactive iodine therapy improves overall survival outcome in oncocytic carcinoma of the thyroid by reducing death risks from noncancer causes: A competing risk analysis of 4641 patients

Zhang,

Wang,

Wei

et al. 2024

Head & Neck

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BackgroundOncocytic carcinoma of the thyroid (OCA) is an independent type of thyroid cancer. Radioactive iodine (RAI) therapy was frequently administered to OCA patients, but its contribution to improving survival is indefinite.Methods4641 OCA patients from 2000 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression and competing risk analysis were applied.ResultsTumor size, SEER stage, primary surgery, and neck dissection were prognostic factors for cancer‐specific survival. The results of competing risk analysis demonstrated that age over 55 years dramatically increased non‐OCA death risks. Treatments that improve non‐OCA survival (including total thyroidectomy, RAI therapy, and systemic therapy) should be recommended in OCA patients older than 55 years of age. Neck lymphadenectomy should not be recommended for OCA, since the metastatic lymph node ratio was low (about 3%).ConclusionsRAI therapy can improve survival in OCA by reducing noncancer death risks.

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

Cited by 15 publications

References 31 publications

Oncocytic Papillary Thyroid Carcinoma and Oncocytic Poorly Differentiated Thyroid Carcinoma: Clinical Features, Uptake, and Response to Radioactive Iodine Therapy, and Outcome

Oncocytic Papillary Thyroid Carcinoma and Oncocytic Poorly Differentiated Thyroid Carcinoma: Clinical Features, Uptake, and Response to Radioactive Iodine Therapy, and Outcome

Clinical impact of follicular oncocytic (Hürthle cell) carcinoma in comparison with corresponding classical follicular thyroid carcinoma

Radioactive iodine therapy improves overall survival outcome in oncocytic carcinoma of the thyroid by reducing death risks from noncancer causes: A competing risk analysis of 4641 patients

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