Cleveland Clinic Investigates Recurrence in Aggressive Variants of Thyroid Cancer

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.

Patients with the hobnail variant and other aggressive histologies often do not do as well as those with other forms of thyroid cancers, and local recurrences may be more likely in these patient populations. They often do not respond to therapy, require many more surgeries, or require radiation. Hobnail morphology, specifically, doesn’t respond to standard 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 mortality in these patients with hobnail morphology. In their analysis of 45 patients with hobnail morphology, they found that age above 55 years old, clinical stage T3/T4 disease, and positive surgical margins were associated with inferior event-free survival rates.

Although researchers believe this is the largest reported investigation 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 may live for years, but the morbidity associated with local recurrence is still substantial and is an important area for research.

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