Santini, Joseph1; Gotlib, Julia1; Dassonville, Olivier1; Lassalle, Sandra2; Peyrottes, Isabelle3; Sadoul, Jean-louis4; Benisvy, Danielle3
1 Head and neck Institute, University of Nice Sophia Antipolis , Nice, France
2 Department of pathology, University hospital of Nice, Nice, France
3 Antoine Lacassagne Cancer Center, Nice , France
4 Department of endocrinology, University hospital of Nice, Nice, France
Background: A limited number of studies specifically examine follicular thyroid carcinomas (FTC), which comprise less than 10% of differentiated thyroid cancers (DTC).
Objectives: The purpose of this study was to investigate the prognostic factors of FTC in a large series of patients treated at a single institution.
Methods: we retrospectively analyzed data of 1713 patients with a thyroid cancer who were treated and followed at Nice University Hospital between 2000 and 2014.
We found 125 patients with FTC and divided them into two subtypes: 73 with classical FTC (CFTC) and 52 with Hürtle cell thyroid cancer (HTC).
Results: In our study, patients with a HTC present a better node metastasis rate (0.8%) and distant metastasis rate (0%) than patients with a CFTC (4% of nodal metastasis, 6.4% of distant metastasis). Prognosis factors of the two FTC subtypes are mostly the same as for the whole population of DTC (age over 45 years, tumor size larger than 4cm), with an additional feature: the significance of microscopic aggressiveness criteria (large capsular or vascular invasion, p<0.015).
After treatment 3 patients died of their thyroid cancer, all 3 presented distant metastases from a CFTC.
Conclusion: Overall, FTC and HTC have good long-term survival expectations. The main difference with papillary thyroid cancers lies in the lower rate of nodal metastases. In our study, only CFTC are associated with distant metastases and specific deaths.
Discussion: HTC and minimal invasive CFTC could be studied for a therapeutic de-escalation protocol.
- Randolph, G. W. et al. The Prognostic Significance of Nodal Metastases from Papillary Thyroid Carcinoma Can Be Stratified Based on the Size and Number of Metastatic Lymph Nodes, as Well as the Presence of Extranodal Extension. Thyroid 22, 121019101449003 (2012).
- Dionigi, G. et al. Minimally invasive follicular thyroid cancer (MIFTC)–a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbeck’s Arch. Surg. 399, 165–84 (2014)
- Lalmi, F., Sadoul, J.-L. & Rohmer, V. [Thyroid cancers: from epidemiology to molecular biology]. Ann. Endocrinol. (Paris). 76, S19–28 (2015)
- Goffredo, P., Roman, S. A. & Sosa, J. A. Hurthle cell carcinoma: A population-level analysis of 3311 patients. Cancer 119, 504–511 (2013).