Hashimoto's thyroiditis predicts outcome in intrathyroidal papillary thyroid cancer

Hashimoto's thyroiditis (HT) seems to have favourable prognostic impact on papillary thyroid cancer (PTC), but data were obtained analyzing all disease stages. Given that HT-related microenvironment involves solely the thyroid, we aimed to assess relationship between HT, as detected through pathological assessment, and outcome in intrathyroidal PTC. This was a multicenter, retrospective, observational study including 301 PTC with no evidence of extrathyroidal disease. Primary study endpoint was the rate of clinical remission. Auxiliary endpoint was recurrence-free survival (RFS). HT was detected in 42.5% of the cohort and was associated to female gender, smaller tumour size, lower rate of aggressive PTC variants, and less frequent post-surgery radio-iodine administration. HT showed relationship with significantly higher rate of clinical remission (p<0.001, OR 4, 95% CI 1.78-8.94). PTCs with concomitant HT had significantly longer RFS, as compared with non-HT tumours (p=0.004). After adjustement for other parameters affecting disease outcome at univariate analysis (age at diagnosis, histology, tumour size, and multifocality), prognostic effect of HT remained significant (p=0.006, OR 3.28, 95% CI 1.39-7.72). Nevertheless, assessment of HT accuracy as prognostic marker showed poor capability of identifying patients with unfavourable outcome (negative predictive value of clinical remission was 21.05, 95% CI 18.2-24.22). Our data show that HT represents an independent prognostic parameter in intrathyroidal PTC, but cannot improve prognostic specificity.