Prognosis

The 10-year survival rates for the classes of well-differentiated thyroid cancers are papillary, 95%; follicular, 85%; and Hurthle cell, 70%. The cause-specific 20-year mortality for Hurthle cell carcinomas has been reported to range from 20% to 35%.34 Prognosis generally depends on extent of disease at the initial diagnosis and the possibility of resection. The most favorable prognosis is associated with disease confined to the thyroid gland itself. A strong correlation has been demonstrated between tumor DNA aneuploidy and decreased survival in Hurthle cell carcinomas.35 However, adenomas often have an aneuploid DNA status and do not recur or metastasize. Therefore, aneuploidy is not an unfavorable prognostic factor. Studies that have focused strictly on Hurthle cell cancers have failed to identify useful prognostic factors such as age at diagnosis, tumor size, histologic grade, and tumor growth pattern.10 None of these factors have been found to be associated with survival advantage. There is universal agreement, however, that adequate surgical resection (at least total lobectomy) is the treatment of choice of all Hurthle cell carcinomas.

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