| PROGNOSTIC FACTORS |
The pathologic criterion for malignancy is more frequently
met for Hurthle cell neoplasms than for other follicular tumors
NOTE: Size, nuclear atypia, multinucleation, cellular pleomorphism,
mitoses, or histologic pattern are not predictive of behavior
30-40% of solitary encapsulated tumors will show invasive characteristics |
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Prognostic factors in patients with Hurthle cell neoplasms of the thyroid.
Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S,
Ordonez NG, Sherman SI.
Department of Endocrine Neoplasia and Hormonal Disorders, The
University of Texas M. D. Anderson Cancer Center, Houston, Texas.
|
Cancer 2003 Mar 1;97(5):1186-94 Abstract quote BACKGROUND: Hurthle
cell neoplasms, often considered a variant of follicular thyroid neoplasms,
represent 3% of thyroid carcinomas. Only a handful of publications have
focused on the biologic behavior, prognostic factors, and treatment
outcomes of Hurthle cell carcinoma. The objective of the current study
was to identify the clinical and pathologic features of Hurthle cell
carcinomas that predict disease progression or death.
METHODS: The authors reviewed medical records of patients who were
treated for Hurthle cell carcinoma (HCC) and Hurthle cell adenoma (HCA)
at The University of Texas M. D. Anderson Cancer Center from March 1944
to February 1995, including follow-up information. The pathologic diagnosis
was confirmed by one of the authors.
RESULTS: The authors identified 127 patients with Hurthle cell neoplasms,
89 patients with HCC and 38 patients with HCA. Seven patients with HCC
had foci of anaplastic thyroid carcinoma. Survival for this subgroup
was worse compared with the overall group and was analyzed separately.
The HCC group was significantly older (age 51.8 years vs. age 43.1.
years) and had larger tumors (4.3 cm vs. 2.9 cm) compared with the HCA
group. No differences were seen in gender or previous radiation exposure.
Forty percent of patients in the HCC group died of thyroid carcinoma,
whereas no patients in the HCA group died of the disease. There has
been no improvement in all-cause and disease specific mortality in the
past 5 decades for patients with these neoplasms. Conventional staging
systems predicted mortality with minor differences. Of the patients
with known metastasis, 38% showed radioiodine uptake. Univariate analysis
identified older age, higher disease stage, tumor size, extraglandular
invasion, multifocality, lymph node disease, distant metastasis, extensive
surgery, external beam radiation therapy, and chemotherapy as factors
that were associated with decreased survival. Tumor encapsulation was
associated with improved survival. Although radioactive iodine treatment
had no overall effect on survival, subgroup analysis showed that patients
who received radioactive iodine for adjuvant ablation therapy had better
outcomes compared either with patients who did not receive radioactive
iodine or with patients who received radioactive iodine as treatment
for residual disease. Multivariate analysis indicated that older age
and larger tumor size predicted worse survival through an association
with worse behaving tumors (multifocal, less encapsulated, and with
extraglandular invasion). The decreased survival in patients with lymph
node metastases may be explained by its association with distant metastases.
The association of extensive surgery, external beam radiation therapy,
and chemotherapy with worse survival also disappeared once those factors
were analyzed together with other prognostic factors, such as distant
metastases.
CONCLUSIONS: Several clinical and pathologic prognostic factors were
identified in patients with HCC and HCA. Older age and larger tumor
size predicted reduced survival. Radioactive iodine therapy may confer
a survival benefit when it is used for adjuvant ablation therapy, but
not when residual disease is present. The authors could not demonstrate
a survival benefit for the use of extensive surgery, external beam radiation
therapy, or chemotherapy. |
Survival and prognosis in Hurthle cell carcinoma of the thyroid gland.
Bhattacharyya N.
Division of Otolaryngology, Brigham and Women's Hospital, 333
Longwood Ave, Boston, MA 02115, USA.
|
Arch Otolaryngol Head Neck Surg 2003 Feb;129(2):207-10 Abstract quote
OBJECTIVE: To determine factors that affect survival in patients with
Hurthle cell carcinoma of the thyroid gland.
METHODS: Data for all cases of Hurthle cell carcinoma that occurred
between January 1, 1988, and December 31, 1998, were extracted from
the Surveillance, Epidemiology, and End Results database. Clinical data
regarding age, sex, tumor size, primary site extension, nodal involvement,
and vital status were tabulated. Patients with distant metastases were
excluded, and Kaplan-Meier survival analysis was conducted. Survival
data for patients with Hurthle cell carcinoma were compared with data
for a control group of patients with follicular cell carcinoma matched
for age, sex, tumor size, and local disease extension. Cox multivariate
regression analysis was conducted to determine the effect of predictor
variables on overall survival in Hurthle cell carcinoma.
RESULTS: We identified 555 cases of nonmetastatic Hurthle cell carcinoma
(mean age at diagnosis, 55.9 years; women, 67.9%). The primary tumor
was intrathyroidal in 83.8% of patients, whereas 11.2% had minor local
extension. Mean tumor size was 3.5 cm. Mean, 5-year, and 10-year survival
for Hurthle cell carcinoma was 109 months, 85.1%, and 71.1%, respectively.
Mean survival for 411 matched patients with follicular cell carcinoma
was 113 months, which was not statistically different from that of patients
with Hurthle cell carcinoma (P =.47, log-rank test). On multivariate
analysis, increasing age at diagnosis, male sex, and increasing tumor
size were statistically significant predictors of poor survival; degree
of primary site extension did not affect survival.
CONCLUSIONS: Overall survival for Hurthle cell carcinoma is similar
to that of comparably staged follicular cell carcinoma. Increasing age,
male sex, and increasing tumor size substantially diminish survival
in patients with Hurthle cell carcinoma.
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Hurthle cell tumors of the thyroid gland. Personal experience and review
of literature.
Bononi M, De Cesare A, Cangemi V, Fiori E, Galati G, Giovagnoli
MR, Izzo L, Cimitan A, Meucci M, Cavallaro A.
Department of General Surgery, Pietro Valdoni University of
Rome La Sapienza, Via Talete no. 45, 00124 Roma, Italy.
|
Anticancer Res 2002 Nov-Dec;22(6B):3579-82 Abstract quote
BACKGROUND: Oncocytic cell neoplasm of the thyroid is currently recognized
as a histological entity, but doubts still exist about its clinical
and evolutionary categorization. Controversies concern occurrence and
frequency of malignant forms, natural history and therapeutic strategies.
MATERIALS AND METHODS: The authors report six cases of Hurthle cell
tumor. Five cases were adenoma, one was carcinoma. Morpho-functional
pre-operative evaluation and inter-operative histopathological test
were performed in all patients. One patient underwent lobectomy (absence
of unusual characteristics of the adenoma Hurthle cell) and five underwent
total thyroidectomies (1 carcinoma). All patients were treated with
suppressive hormonal therapy.
RESULTS: No mortality and morbidity was recorded. All patients are
undergoing follow-up (adenomas: average 64.2 months; carcinoma: 132
months) and none of them show recurrent symptoms.
DISCUSSION: Hurthle cell tumors can be diversified in adenoma and carcinoma.
Almost all reports classify oncocytic nodules as malignant when capsular
and/or vascular invasion is present or when there is peri-thyroid tissue
infiltration or lymphatic or hematic metastases. A clear differentiation
between adenoma and carcinoma is determined by a histological test.
Also an intra-operative histopathological analysis is sometimes unable
to show minimal signs of invasion. Conflicting observations about the
biological behaviour of Hurthle cell neoplasm lead to different therapeutic
strategies. The authors believe lobectomy is the treatment of choice
when a clear histological diagnosis of adenoma has been made. When carcinoma
is diagnosed or when doubts exist after intraoperative histological
test, the authors recommend total thyroidectomy followed by scintigraphic
test and preventive radio-active therapy. All patients should be treated
with suppressive hormonal therapy and undergo periodic check-ups. |
