Differentiated thyroid cancer outcomes comparable in immunocompromised patients

DTC is highly curable, with less than 1% disease-related mortality and growing support for active surveillance in low-risk papillary microcarcinomas. While high-risk features include older age, extrathyroidal extension, and nodal metastases, the effect of immunodeficiency on DTC behavior remains unclear due to limited data from small patient series.

In this retrospective study, researchers aimed to fill the knowledge gap in immunocompromised patients compared with a propensity-matched group of immunocompetent control individuals by evaluating the clinical features and outcomes of DTC.

The study included 8534 adult patients who were treated at the Memorial Sloan-Kettering Cancer Center between 1987 and 2020. Among these patients, 130 (1.5%) were immunocompromised, including those with end-stage renal disease (ESRD), HIV infection, solid organ transplantation (SOTR), or ongoing immunosuppressive therapy for other diseases. After propensity score matching, 650 immunocompetent patients were included for comparison.

Within the immunocompromised cohort, 90% of tumors were T1–T2, and nearly 80% were node-negative (N0). Patients with HIV and ESRD had higher rates of nodal metastasis and tall-cell subtype, while SOTR patients and those with autoimmune diseases showed higher recurrence rates. Overall, 76% of patients had total thyroidectomy, a quarter of immunocompromised patients received postoperative adjuvant radioactive iodine, and no one required radiation therapy.

No significant differences in recurrence-free survival (RFS) or disease-specific survival (DSS) were observed between immunocompromised and immunocompetent patients.

Among the entire immunocompromised cohort vs immunocompetent patients, 10-year RFS was 95% (95% CI, 90%–99%) vs 93% (95% CI, 90%–96%; P =.94), and 10-year DSS was 100% vs 98% (95% CI, 96%-100%; P =.34).

For SOTR patients vs matched immunocompetent control participants, 10-year RFS was 91% (95% CI, 75%-100%) vs 98% (95% CI, 95%-100%; P =.28), with most recurrences occurring within the first 5 years. The 10-year DSS was 100% in SOTR vs 96% (95% CI, 90%-100%) in control participants (P =.48).

Study limitations include its retrospective design, which restricted analysis to DTC treated after immunodeficiency diagnosis and limited subgroup sizes, reducing the ability to assess untreated disease progression and draw distinct conclusions across immunocompromised groups.

The study authors concluded, “The results confirm that DTC behaves similarly in both groups, with a comparable prognosis. These findings strengthen the limited data available in the literature, advocating for a similar approach to managing DTC in both immunocompromised and immunocompetent patients.”

By Oladimeji Ewumi

References:

Ritter A, Eagan A, Levyn H, et al. Comparable outcomes of differentiated thyroid cancer in immunocompromised versus immunocompetent patients. J Clin Endocrinol Metab. Published online October 7, 2025. doi:10.1210/clinem/dgaf550