Purpose <p>This study aimed to examine survival outcomes, metastatic patterns, and local invasion features of oncocytic papillary thyroid carcinomas (O-PTC) and oncocytic carcinomas (OCA).</p> Methods <p>We retrieved data for patients diagnosed with O-PTC and OCA between 2000 and 2021 from the SEER database. Kaplan-Meier analysis and log-rank tests compared overall survival (OS) and cancer-specific survival (CSS) between groups and across TNM stages within the OCA cohort. Multivariate Cox regression was applied to metastatic OCA cases to estimate hazard ratios for OS and CSS.</p> Results <p>Among 3,909 patients, 322 (8.24%) had O-PTC and 3,587 (91.76%) had OCA. The O-PTC group demonstrated significantly better OS and CSS than the OCA group. At 60 months, OS and CSS in the O-PTC group were 96.6% and 98%, respectively, compared to 91.0% and 95.2% in the OCA group. Mortality was lower in the O-PTC cohort (4.66%, with 26.67% cancer-related deaths) than in the OCA cohort (16.20%, with 36.14% cancer-related deaths). Among OCA patients, 4.66% were staged as T4, lungs and bones were the most frequent metastatic sites for both groups. Stage-specific analysis revealed a significant decline in survival with advancing AJCC stage, with 60-month OS rates dropping from 96.8% in Stage I to 29.63% in Stage IVB, and corresponding CSS rates decreasing from 99.3% to 33.99%.</p> Conclusion <p>O-PTC patients exhibit significantly better OS and CSS compared to those with OCA, however, no survival difference is observed between the two groups when stratified by TNM stage. The 8th edition AJCC staging system has proven to be a reliable predictor of outcomes in OCA, highlighting the critical importance of precise staging.</p>