The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart

Abstract

Background: This population study compared the treatment and prognosis of Hürthle cell follicular thyroid carcinoma (HCFC) and non-HCFC.

Methods: The Surveillance, Epidemiology and End Results database identified patients with HCFC and non-HCFC from 1988 to 1993 who were followed to 2001. Treatment of each carcinoma was compared, and the effect of prognostic factors on survival was analyzed.

Results: Eight hundred forty-five patients were identified; 172 patients (20%) had HCFC and 673 patients (80%) had non-HCFC. Total thyroidectomy was performed in 80% of patients with HCFC compared with 69% with non-HCFC (P = .005). Radioactive iodine was used in 33% with HCFC and 45% with non-HCFC (P = .003). The crude 10-year survival was 73% in HCFC and 83% in non-HCFC patients. Older age (> or =50 vs <50 years; hazard ratio, 6.35; 95% CI, 4.07-9.93), men (hazard ratio, 2.07; 95% CI, 1.52-2.81), larger tumor size (>5 vs < or =5 cm; hazard ratio, 2.20; 95% CI, 1.55-3.13; >10 cm vs < or =5 cm; hazard ratio, 3.28; 95% CI, 1.12-9.61), nodal metastases (hazard ratio, 3.11; 95% CI, 1.80-5.37), and distant metastases (hazard ratio, 3.91; 95% CI, 1.94-7.90) were associated with a higher mortality rate. Histologic type (non-HCFC vs HCFC; hazard ratio, 0.85; 95% CI, 0.60-1.19; P = .34), local extension, extent of thyroidectomy, and radioactive iodine use had no effect on the mortality rate.

Conclusions: Histologic distinction between HCFC and non-HCFC is not as prognostically important as age, gender, and tumor stage. This study suggests that patients with HCFC should be treated the same as patients with equivalent stage non-HCFC.