Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Endocrine Surgery, University College London Hospital, NHS Trust, London, UK; Department of Surgery, Alexandria University, Alexandria, Egypt.
Department of Radiology, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
J Surg Res. 2019 May;237:56-60. doi: 10.1016/j.jss.2018.12.021. Epub 2019 Jan 25.
This study compares the outcome of parathyroidectomy for primary hyperparathyroidism (PHPT) in patients whose adenomas' weights were at the extremes of the distribution curve. As the size of parathyroid adenomas influences the success rate of localization studies for PHPT, it is possible that a difference in cure rate could be observed between subgroups of patients.
Data were retrieved from a prospective database maintained in a large university hospital.
From a cohort of 519 patients who underwent parathyroidectomy for PHPT, two subgroups of patients were identified based on the extreme 10% of the distribution curve for adenomas' weight: adenomas <300 mg ("dwarfs", n = 100, median 200 mg) and >3000 mg ("giants", n = 56, median 4300 mg). In comparison with giant adenomas, dwarf adenomas were associated with less severe hypercalcemia (median 2.84 versus 3.00 mmol/L, P < 0.001) and lower PTH (median 11.7 versus 25.6 pmol/L, P < 0.001). The occurrence of dwarf adenomas showed no trend during the study period (23/173 [13%] in 2000-2004 versus 36/217 [17%] in 2007-2011). Scan-directed parathyroidectomy was feasible in more patients with giant adenomas (59% versus 38%). Persistent disease was diagnosed in three patients with dwarf adenomas. Patients with giant adenomas had no recurrence during a follow-up of 40 mo even though eight patients had histological features suggestive of atypical/malignant tumors.
Preoperative biochemistry is a poor predictor of adenomas' size even at the extremes of the distribution curve. Cure can be achieved in all patients with "dwarf" adenomas. Even in the presence of suspicious histological features, "giant" adenomas did not show malignant behavior.
本研究比较了原发性甲状旁腺功能亢进症（PHPT）患者的甲状旁腺瘤体重处于分布曲线极端的手术结果。由于甲状旁腺瘤的大小会影响 PHPT 的定位研究成功率，因此在患者亚组之间可能观察到治愈率的差异。
数据来自于一家大型大学医院的前瞻性数据库。
在接受 PHPT 甲状旁腺切除术的 519 名患者中，根据腺瘤重量分布曲线的极端 10%确定了两个亚组患者：腺瘤<300mg（“矮人”，n=100，中位数 200mg）和>3000mg（“巨人”，n=56，中位数 4300mg）。与巨大腺瘤相比，小腺瘤与更严重的高钙血症相关（中位数 2.84 与 3.00mmol/L，P<0.001）和更低的 PTH（中位数 11.7 与 25.6pmol/L，P<0.001）。在研究期间，小腺瘤的发生率没有趋势（2000-2004 年 23/173[13%]与 2007-2011 年 36/217[17%]）。在更多的巨大腺瘤患者中可行扫描引导甲状旁腺切除术（59%与 38%）。三名小腺瘤患者被诊断为持续性疾病。尽管 8 名患者具有提示非典型/恶性肿瘤的组织学特征，但在 40 个月的随访中，巨大腺瘤患者没有复发。
即使在分布曲线的极端，术前生化检查也不能很好地预测腺瘤的大小。所有“矮人”腺瘤患者都可以治愈。即使存在可疑的组织学特征，“巨人”腺瘤也没有表现出恶性行为。
