Hsu Kun-Tai, Sippel Rebecca S, Chen Herbert, Schneider David F
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Surgery. 2014 Dec;156(6):1336-41; discussion 1341. doi: 10.1016/j.surg.2014.08.005. Epub 2014 Nov 11.
Parathyroid carcinoma is a rare cancer. Unlike other more common malignancies, the importance of lymph node (LN) status remains controversial. The purpose of this study was to determine the relative importance of LN metastases in disease-specific survival (DSS).
A retrospective review of the Surveillance, Epidemiology, and End Result database was performed on parathyroid carcinoma cases diagnosed between 1988 and 2010.
We identified 405 parathyroid carcinoma patients. Among 114 patients with LNs examined at operation, only 12 (10.5%) had positive LNs. Sensitivity analysis found that a tumor size threshold of 3 cm best divided the cohort by DSS. Only tumors ≥ 3 cm and distant metastasis but not LN metastases were independent prognostic factors on multivariate analysis. When examining factors associated with LN status, only tumors ≥ 3 cm predicted LN metastasis. LN metastases were 7.5 times more likely in patients with tumors ≥ 3 cm than those with tumors <3 cm.
Tumors ≥ 3 cm were associated with LN metastases in parathyroid carcinoma, but positive LN status was not associated with DSS. Tumor size can potentially risk stratify patients by their risk of LN metastases.
甲状旁腺癌是一种罕见的癌症。与其他更常见的恶性肿瘤不同，淋巴结（LN）状态的重要性仍存在争议。本研究的目的是确定LN转移在疾病特异性生存（DSS）中的相对重要性。
对1988年至2010年间诊断的甲状旁腺癌病例进行了监测、流行病学和最终结果数据库的回顾性研究。
我们确定了405例甲状旁腺癌患者。在114例术中检查了LN的患者中，只有12例（10.5%）LN呈阳性。敏感性分析发现，肿瘤大小阈值为3 cm时，按DSS对队列进行划分效果最佳。多因素分析显示，只有肿瘤≥3 cm和远处转移而非LN转移是独立的预后因素。在检查与LN状态相关的因素时，只有肿瘤≥3 cm可预测LN转移。肿瘤≥3 cm的患者发生LN转移的可能性是肿瘤<3 cm患者的7.5倍。
在甲状旁腺癌中，肿瘤≥3 cm与LN转移相关，但LN阳性状态与DSS无关。肿瘤大小可根据患者发生LN转移的风险对其进行潜在的风险分层。
