Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Endocrinol Metab (Seoul). 2021 Oct;36(5):1078-1085. doi: 10.3803/EnM.2021.1151. Epub 2021 Oct 28.
Hürthle cell carcinoma (HCC), a type of thyroid carcinoma, is rare in South Korea, and few studies have investigated its prognosis.
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.
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).
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.
Hürthle 细胞癌（HCC）是一种甲状腺癌，在韩国较为罕见，且鲜有研究对其预后进行探讨。
本长期多中心回顾性队列研究评估了 1996 年至 2009 年间接受甲状腺切除术的 HCC 患者的临床病理特征和临床结局。
研究纳入的 97 例患者的平均年龄为 50.3 岁，26.8%为男性。原发肿瘤的平均大小为 3.2±1.8cm，3 例（3.1%）患者在初诊时即发生远处转移。73 例患者的超声检查结果可供评估；根据韩国甲状腺影像报告和数据系统（Korean-Thyroid Imaging Reporting and Data System），低、中、高度可疑结节的数量分别为 28（38.4%）、27（37.0%）和 18（24.7%）。术前，根据 Bethesda 分类，滤泡性肿瘤（FN）或疑似 FN 占 65.2%，13%的病例有恶性或疑似恶性。中位随访 8.5 年后，8（8.2%）例患者出现持续性/复发性疾病，无 HCC 死亡病例。年龄较大、肉眼甲状腺外侵犯（ETE）和广泛浸润性肿瘤类型与远处转移显著相关（均 P<0.01）。肉眼 ETE（风险比 [HR]，27.7；95%置信区间 [CI]，2.2 至 346.4；P=0.01）和广泛浸润性分类（HR，6.5；95% CI，1.1 至 39.4；P=0.04）是无病生存（DFS）的独立预后因素。
本研究中，韩国 HCC 的长期预后相对较好，但这并非全国性数据，肉眼 ETE 和广泛浸润性癌症是 DFS 的显著预后因素。超声和细胞学诊断 HCC 仍然具有挑战性。
