Shlomo Koyfman, MD, the director of head and neck and skin cancer radiation at Cleveland Clinic, discusses factors that are associated with the risk of recurrence and death in patients with papillary thyroid cancer (PTC) with hobnail morphology, an aggressive variant that has been associated with poorer outcomes.
Hobnail histology and other aggressive histologies do not do as well as other thyroid cancers. They often do not respond to therapy, require many more surgeries, or require radiation. Hobnail morphology, specifically, doesn’t respond to radioactive iodine, so it is important to identify this population.
The Cleveland Clinic presented data at the 2019 ASCO Annual Meeting that demonstrated several factors that are potentially associated with recurrence and death in these patients with hobnail morphology. In their analysis of 45 patients with hobnail morphology, they found age greater than 55 years old, T3/T4 disease, and positive surgical margins were associated with inferior event-free survival.
While researchers believed this was the largest reported cohort of this patient population, further analysis is necessary to validate these findings.
Investigating aggressive thyroid cancers including hobnail and other variants is a new field of research but very important, says Koyfman. PTC is a chronic disease and many patients with metastatic PTC live for years, the rate of recurrence and death is substantial.
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