Hürthle cell (Oncocytic) carcinoma – Is hemithyroidectomy enough?

Background Hürthle cell carcinoma (HCC) has traditionally been managed with total thyroidectomy. However, current evidence suggests a limited benefit to this approach due to the lack of radioactive iodine uptake. We sought to compare outcomes of HCC managed with hemi- (HEMI) vs. total thyroidectomy (TOTAL). Methods A retrospective review of 309 patients who had surgery for HCC from 2000–2019 was performed. A subcohort was selected that matched each HEMI to a paired TOTAL on age and TNM stage. Associations of clinical and pathological features with surgery type were examined using paired t-tests and exact McNemar tests. Survival and recurrence were examined using Cox regression analysis. Results 295 patients were in the study cohort, 42 (14%) HEMI and 253 (86%) TOTAL. Of the 42 HEMI; 69% were female, median age 57 years, Tx/T1 = 16, T2/T3 = 26, nodal disease in 1 and metastatic in 1. Compared to the 42 matched TOTAL, we found no associations of surgery type with age and TNM stage. Surgery type was also not associated with gender, race, pathology or focality (p > 0.05). Over a mean follow-up of 7.0 years in the matched cohort, there were 10 recurrences (8 TOTAL, 2 HEMI), 11 deaths (5 TOTAL, 6 HEMI) and 3 deaths from HCC (3 TOTAL, 0 HEMI). There were no differences in recurrence-free survival (p = 0.065), overall survival (p = 0.806) or disease-specific survival. Conclusion Hemithyroidectomy is a reasonable treatment option for HCC. Extent of thyroidectomy does not affect recurrence-free survival or overall survival in our matched cohort. Synopsis Single institution study with 295 patients with Hürthle cell carcinoma. A case-matched cohort to control for age and stage was used to compare hemi- versus total thyroidectomy. The extent of thyroidectomy did not affect recurrence free survival or overall survival.