From the Guidelines
The prognosis for Hurthle cell neoplasms is generally favorable, with an overall 5-year survival rate of approximately 85-95% for malignant cases, and most patients (about 80%) having benign adenomas with excellent prognosis following surgical removal. The prognosis varies depending on whether the tumor is benign or malignant, and several factors influence the outcome, including tumor size, vascular invasion, lymph node involvement, and distant metastasis 1. Tumors smaller than 4 cm, without vascular invasion, lymph node involvement, or distant metastasis have a better prognosis. Age is also significant, with patients under 45 having more favorable outcomes. Treatment typically involves total thyroidectomy, with possible lymph node dissection if metastasis is suspected. Following surgery, radioactive iodine therapy may be recommended, though Hurthle cell carcinomas often show reduced iodine uptake compared to other thyroid cancers. Long-term monitoring includes thyroglobulin level measurements, neck ultrasounds, and thyroid-stimulating hormone (TSH) suppression therapy with levothyroxine.
Some key points to consider in the management of Hurthle cell neoplasms include:
- Molecular diagnostics may not perform well for Hurthle cell neoplasms, and their use is not recommended for these cases 1.
- Clinical risk factors, sonographic patterns, and patient preference can help determine whether active surveillance or lobectomy is appropriate.
- The aggressive nature of some Hurthle cell carcinomas stems from their unique cellular characteristics, including abundant mitochondria and potential for hematogenous spread, making close follow-up essential even years after initial treatment.
- The NCCN guidelines provide recommendations for the management of thyroid carcinoma, including Hurthle cell neoplasms, and emphasize the importance of individualized treatment plans based on the specific characteristics of each patient's disease 1.
Overall, the prognosis for Hurthle cell neoplasms is generally favorable, but careful management and follow-up are necessary to ensure optimal outcomes. Total thyroidectomy, with possible lymph node dissection, and long-term monitoring with thyroglobulin level measurements, neck ultrasounds, and TSH suppression therapy are key components of the treatment plan.
From the Research
Hurthle Cell Neoplasm Prognosis
- The prognosis of Hurthle cell neoplasm is generally favorable, with a cancer-specific survival rate of 92% at 5 years, as reported by 2.
- Factors that predict adverse outcomes include tumor size greater than 4 cm, age older than 60 years, and complete capsular invasion on surgical pathologic findings, as noted in 3.
- The size of the Hurthle cell neoplasm is a significant predictor of malignancy, with tumors larger than 4 cm having a 65% chance of being malignant, according to 4.
- Patient age is also a predictor of malignancy, with patients older than 45 years having a higher risk of malignancy, as reported by 5.
- Treatment with total thyroidectomy, radioiodine, and selective use of external-beam radiotherapy can result in a favorable outcome, with a relapse-free survival rate of 65% at 5 years, as shown in 2.
- The overall rate of malignancy in patients with Hurthle cell neoplasm is around 35-46%, as reported by 4 and 5.
- Fine-needle aspiration biopsy and intraoperative frozen section analysis have low sensitivities in detecting cancer, making it challenging to diagnose malignancy preoperatively, as noted in 4.