Hundahl S A, Fleming I D, Fremgen A M, Menck H R
Department of Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA.
Cancer. 1999 Aug 1;86(3):538-44. doi: 10.1002/(sici)1097-0142(19990801)86:3<538::aid-cncr25>3.0.co;2-k.
In combination with other Commission on Cancer programs, the National Cancer Data Base (NCDB), a national electronic registry system currently capturing > 60% of incident cancers in the U. S., offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is proving to be of particular value in capturing clinical information concerning rare cancers.
For accession years 1985-1995, the NCDB captured prospectively collected demographic, stage, treatment, and outcome information for a national hospital-based sample of 286 parathyroid carcinoma cases (0.005% of the total NCDB cancer cases). This report describes clinical and demographic features as well as patterns of care and 5-year and 10-year relative survival rates.
The NCDB's 10-year accrual of parathyroid carcinoma cases exceeded the cumulative number reported in the English literature though 1991. Gender distribution was equal. The authors were unable to detect any disproportionate clustering by race, income level, or geographic region. Treatment overwhelmingly was surgical. The data from the current study suggest that neither tumor size nor lymph node status are significant prognostic factors. Overall relative survival at 5 years and 10 years was 85.5% and 49.1%, respectively.
At 5 years of follow-up, and possibly beyond, neither tumor size nor lymph node status were found to be significant prognostic factors and basing a staging system on them would be useless. Although complete, en bloc resection of all tumor represents the best opportunity for cure, a substantial proportion of patients fail to receive such treatment. The authors speculate that the rarity of this condition and late intraoperative recognition occasionally prevent optimal treatment. [See editorial on pages 378-80, this issue.]
国家癌症数据库（NCDB）与癌症委员会的其他项目相结合，是一个全国性电子登记系统，目前收录了美国超过60%的新发癌症病例，它在地方和国家层面提供了一个自愿、准确且具有成本效益的“结果管理”的实例。此外，事实证明它在收集罕见癌症的临床信息方面具有特殊价值。
对于1985 - 1995年的入组年份，NCDB前瞻性收集了来自全国医院的286例甲状旁腺癌病例（占NCDB癌症病例总数的0.005%）的人口统计学、分期、治疗及结果信息。本报告描述了临床和人口统计学特征、治疗模式以及5年和10年相对生存率。
NCDB在10年里积累的甲状旁腺癌病例数超过了截至1991年英国文献报道的累计病例数。性别分布均衡。作者未能发现按种族、收入水平或地理区域存在任何不成比例的聚集现象。绝大多数治疗方式为手术。当前研究数据表明，肿瘤大小和淋巴结状态均不是显著的预后因素。5年和10年的总体相对生存率分别为85.5%和49.1%。
在5年随访期及可能更长时间内，未发现肿瘤大小和淋巴结状态是显著的预后因素，基于它们建立分期系统将毫无用处。尽管完整整块切除所有肿瘤是治愈的最佳机会，但相当一部分患者未接受此类治疗。作者推测，这种疾病的罕见性以及术中识别较晚偶尔会妨碍最佳治疗。[见本期第378 - 380页的社论。]
