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Hurthle cell carcinoma†
A population-level analysis of 3311 patients
Article first published online: 14 AUG 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 3, pages 504–511, 1 February 2013
How to Cite
Goffredo, P., Roman, S. A. and Sosa, J. A. (2013), Hurthle cell carcinoma. Cancer, 119: 504–511. doi: 10.1002/cncr.27770
All authors 3 authors contributed to 1) conception and design or analysis and interpretation of data, 2) drafting the article or revising it critically for important intellectual content, and 3) final approval of the version to be published.
- Issue published online: 22 JAN 2013
- Article first published online: 14 AUG 2012
- Manuscript Accepted: 11 JUL 2012
- Manuscript Revised: 10 JUL 2012
- Manuscript Received: 9 JUN 2012
- Hurthle cell carcinoma;
- differentiated thyroid cancer;
- Surveillance, Epidemiology, and End Results;
Hurthle cell carcinoma (HCC) is an uncommon and more aggressive thyroid cancer. To date, there is a paucity of data at a population level. In this study, demographic, clinical, and pathologic characteristics of HCC were investigated and compared with other types of differentiated thyroid cancers (ODTCs). The authors also evaluated disease-specific survival and compliance with American Thyroid Association (ATA) management guidelines from 2009.
The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer. Data analyses were performed using chi-square tests, analysis of variance, Kaplan-Meier analysis, binary logistic regression, and Cox proportional hazards regression.
In total, 3311 patients with HCC and 59,585 patients with ODTC were identified. Compared with ODTC, HCC was more common among men (31.1% vs 23.0% for ODTC; P < .001) and among older patients (mean age, 57.6 years vs 48.9 years for ODTC; P < .001). Patients with HCC presented with higher SEER disease stage (P < .001), and their tumors were larger (36.1 mm vs 20.2 mm for ODTC; P < .001). Fewer patients underwent total thyroidectomy (P = .028). Both overall and disease-specific survival were lower for patients with HCC (P < .001), and neither improved over the last 2 decades (P = .689). After adjustment, age ≥45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio >3.0). Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged ≥65 years (odds ratio [OR], 1.43; P = .002) and among unmarried patients (OR, 1.29; P = .004). Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age ≥65 years (OR, 1.31; P = .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively; P < .001).
HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines. Cancer 2013. © 2012 American Cancer Society.