Characteristics of patients diagnosed with both primary thyroid and primary renal cell carcinoma

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 459-496-Thyroid Neoplasia & Case Reports
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-465
Aubrey A Carhill*1, Danielle R Litofsky2 and Steven I Sherman2
1Baylor College of Medicine, Houston, TX, 2The University of Texas MD Anderson Cancer Center, Houston, TX
Background:Patients with multiple primary malignancies may demonstrate unique clinical characteristics to suggest a common predisposition or lead to different management. Given the association of primary thyroid (TC) and renal cell carcinomas (RCC), we characterized the clinicopathologic features of patients treated for both malignancies (TC/RCC).

Patients and Methods:  TC/RCC patients were identified through the institutional tumor registry and data compiled by retrospective chart review. To compare with broader institutional and national cohorts, we examined patients admitted with either TC or RCC institution-wide and similarly reviewed the NCI Surveillance, Epidemiology, and End-Results (SEER) program for these cancers.

Results:  Among 23,513 patients with TC or RCC seen at our institution between January 1944 and June 2011, 117 patients were diagnosed with both TC (96% differentiated, 4% medullary) and RCC. Of these, 57% were diagnosed with TC before RCC and 39% with RCC before TC. Compared with institutional and SEER data for either primary tumor, we found characteristics unique to TC/RCC patients included balanced gender distributions (51% F:49% M), which significantly differed from institutional cohorts for TC alone (67% F:33% M; p=0.0003) or RCC alone (31% F:69% M; p<0.0001). When compared with SEER cohorts, gender distribution also differed significantly from patients having TC (78% F:22% M; p<0.0001) or RCC alone (41% F:59% M; p=0.02). Our cohort contained a higher proportion of Hispanic patients than SEER (p=0.0006). Mean age of diagnosis for patients with TC diagnosed first was significantly older (52 ± 15 yr) than the institutional TC cohort (45 ± 17 yr; p<0.0001), but mean age for patients with RCC diagnosed first (59 ± 12 yr) was similar to the larger institutional RCC cohort. Of TC/RCC patients, 43% were later diagnosed with other cancers, with 28% being breast cancer. Notably, of TC/RCC female patients, 52% developed a tertiary cancer, with breast cancer accounting for nearly half of these other cancers. Overall survival was similar to the institutional TC cohort, but if RCC was diagnosed first, median survival was improved compared with institutional RCC cohort (12.4 vs. 4.6 yr, p<0.0001).

Conclusions:  These findings suggest a common etiologic mechanism in patients who develop both TC and RCC, but no need for altered management of TC. Better outcome of RCC and an unexpected association with breast cancer in women will require further exploration.

Disclosure: SIS: Scientific Board Member, Veracyte, Inc., Consultant, Roche Pharmaceuticals, Researcher, Pfizer, Inc., Consultant, Pfizer, Inc., Committee Member, Novo Nordisk, Researcher, Genzyme Corporation, Consultant, Genzyme Corporation, Consultant, Eli Lilly & Company, Consultant, Exelixis, Inc., Consultant, Eisai, Scientific Board Member, Bayer, Inc., Consultant, Astra Zeneca, , Up To Date. Nothing to Disclose: AAC, DRL

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