Clinicopathologic Characteristics,Diagnosis And Treatment Of Hurthle Cell Carcinoma

BackgroundThyroid cancer is the most common endocrine tumor,which incidence in recent decades continues to rise up and significantly higher than the other tumors around the world.Papillary thyroid carcinoma and follicular thyroid carcinoma(FTC)are also known as differentiated thyroid cancer(DTC),to be the main pathological type of thyroid cancer.Thyroid Hurthle cell carcinoma(HCC)was classified as a rare variation type of FTC,with 3-4%of all thyroid cancer.Given with the clinical,pathological and molecular spectral characteristics differences between HCC and FTC,the fourth edition of "WHO classification of endocrine organ tumors",published in 2017,reclassified Hurthle cell tumor as an independent disease type.2015 edition of the American Thyroid Association(ATA)guide recommended lobectomy or total thyroidectomy to 1?4 cm DTC,and radioactive iodine(RAI),namely 131 I,therapy to middle-late DTC patients postoperative adjuvant therapy.Because of HCC's higher recurrence rate and disease specific mortality compared with the FTC and lower iodine affinity than other types of DTC,what kind of operation method should HCC patients choose and whether they can benefit from the RAI treatment remain controversial.ObjectiveAnalyze the clinicopathological characteristics and prognosis related factors of HCC,compare different operation methods on survival of HCC patients,assess whether HCC patients can benefit from the RAI treatment.MethodsInformation was extracted from the Surveillance,Epidemiology,and End result(SEER),established by National Cancer Institute,for demographic and clinical information of patients with HCC or FTC from 1998 to 2015.We analyzed of the clinical pathological characteristics and survival rate differences between HCC and FTC,and applied the Cox proportional hazards model related with the prognosis factors into the multivariate analysis.After adjusting confounding factors,we analyzed whether the impact of surgical method and RAI treatment on patient overall survival(OS)and cancer-specific survival(CSS)was statistically different.ResultsAverage onset age of HCC patients is obviously higher than that of the FTC patients(55.2±15.2 years VS 48.5±16.5 years,P<0.001),male ratio of the former is higher than the latter(29.3%VS 27.1%,P<0.05).Proportion of infiltrating to adjacent tissues(12.4%VS 9.8%,P=0.001),lymph node metastasis(4.7%VS 2.6%,P<0.001)and multiple focal carcinoma(16.5%VS 13.3%,P=0.001)of HCC are obviously higher than the proportion of FTC.OS(?2=36.408,P<0.001)and CSS(?2=17.721,P<0.001)of HCC patients are below the FTC patients'.Total thyroidectomy cannot improve HCC patients' CSS compared with lobectomy(HR=1.206,P=0.540).RAI treatment is the adverse factors for CSS of HCC patients who were treated with total thyroidectomy(HR=2.121,P=0.047).ConclusionCompared with the FTC,the onset age and male ratio of HCC patients are higher,the proportion of surrounding infiltration,lymph node and distant metastasis is also higher.These adverse prognostic factors result in the overall poor prognostic.Assessing recurrence risk level and selecting individual operation range for HCC patients are suggested.RAI treatment cannot improve prognosis of patients.