Endocrinol Metab.  2021 Oct;36(5):1078-1085. 10.3803/EnM.2021.1151.

Clinicopathological Characteristics and Disease-Free Survival in Patients with Hürthle Cell Carcinoma: A Multicenter Cohort Study in South Korea

• Jin M
• Kim ES
• Kim BH
• Kim HK
• Kang YE
• Jeon MJ
• Kim TY
• Kang HC
• Kim WB
• Shong YK
• Kim M
• Kim WG

• KMID: 2521955
• DOI: http://doi.org/10.3803/EnM.2021.1151

Abstract

Background
Hürthle cell carcinoma (HCC), a type of thyroid carcinoma, is rare in South Korea, and few studies have investigated its prognosis.
Methods
This long-term multicenter retrospective cohort study evaluated the clinicopathological features and clinical outcomes in patients with HCC who underwent thyroid surgery between 1996 and 2009.
Results
The mean age of the 97 patients included in the study was 50.3 years, and 26.8% were male. The mean size of the primary tumor was 3.2±1.8 cm, and three (3.1%) patients had distant metastasis at initial diagnosis. Ultrasonographic findings were available for 73 patients; the number of nodules with low-, intermediate-, and high suspicion was 28 (38.4%), 27 (37.0%), and 18 (24.7%), respectively, based on the Korean-Thyroid Imaging Reporting and Data System. Preoperatively, follicular neoplasm (FN) or suspicion for FN accounted for 65.2% of the cases according to the Bethesda category, and 13% had malignancy or suspicious for malignancy. During a median follow-up of 8.5 years, eight (8.2%) patients had persistent/recurrent disease, and none died of HCC. Older age, gross extrathyroidal extension (ETE), and widely invasive types of tumors were significantly associated with distant metastasis (all P<0.01). Gross ETE (hazard ratio [HR], 27.7; 95% confidence interval [CI], 2.2 to 346.4; P=0.01) and widely invasive classification (HR, 6.5; 95% CI, 1.1 to 39.4; P=0.04) were independent risk factors for poor disease-free survival (DFS).
Conclusion
The long-term prognosis of HCC is relatively favorable in South Korea from this study, although this is not a nation-wide data, and gross ETE and widely invasive cancer are significant prognostic factors for DFS. The diagnosis of HCC by ultrasonography and cytopathology remains challenging.

Keyword

Thyroid cancer; Hurthle cell carcinoma; Ultrasonography; Prognosis; Recurrence

Figure

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  Fig. 1. (A) Ultrasonographic findings based on the Korean-Thyroid Imaging Reporting and Data System in patients with Hürthle cell carcinoma. (B) Preoperative fine needle aspiration or core needle biopsy based on Bethesda category in patients with Hürthle cell carcinoma. (C) Proportion of Bethesda category according to ultrasonographic feature. AUS, atypia of undetermined significant; FN, follicular neoplasm.

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