Wächter S, Holzer K, Manoharan J, Brehm C, Mintziras I, Bartsch D K, Maurer E
Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
Klinik für Pathologie, Universitätsklinikum Gießen/Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
Chirurg. 2019 Nov;90(11):905-912. doi: 10.1007/s00104-019-1007-0.
Radical en bloc resection of the tumor with ipsilateral hemithyroidectomy and central lymphadenectomy (PTX+HTX) is currently the generally recommended treatment strategy for parathyroid carcinoma (PC) in Germany; however, it remains unclear whether the en bloc resection leads to a prognostic benefit compared to parathyroidectomy (PTX) alone, especially considering disease-free and overall survival.
This study analyzed the survival of patients with PC after PTX+HTX compared to patients with PTX.
Patients with PC were identified from a prospective database and retrospectively analyzed regarding clinicopathological features, surgical treatment, disease-free interval and overall survival.
Out of 1705 patients who were operated on because of primary hyperparathyroidism (pHPT), 18 (1.1%) had histologically confirmed PC. In nine patients PTX+HTX was initially performed and the other nine patients received only PTX. After PTX, all of the nine patients developed a recurrence after a median of 18 months (range 7-84 months), while only one patient had a recurrence after PTX+HTX. After PTX a median three (range 2-18) reoperations were indicated for relapse but after PTX+HTX only one patient had to undergo two relapse surgeries (p < 0.001). The recurrence-free survival after PTX+HTX was significantly longer than after PTX (143 vs. 18 months, p = 0.01), while the overall survival of both groups after a median follow-up of 107.5 months did not significantly differ.
If there is any clinical suspicion of PC, an en bloc resection should be performed to prolong recurrence-free survival and avoid reoperations.
在德国，肿瘤根治性整块切除联合同侧甲状腺叶切除术及中央区淋巴结清扫术（PTX+HTX）是目前推荐的甲状旁腺癌（PC）治疗策略；然而，与单纯甲状旁腺切除术（PTX）相比，整块切除是否能带来预后益处仍不明确，尤其是在无病生存期和总生存期方面。
本研究分析了PTX+HTX术后PC患者与PTX术后患者的生存情况。
从一个前瞻性数据库中识别出PC患者，并对其临床病理特征、手术治疗、无病间期和总生存期进行回顾性分析。
在因原发性甲状旁腺功能亢进（pHPT）接受手术的1705例患者中，18例（1.1%）经组织学确诊为PC。9例患者最初接受了PTX+HTX，另外9例患者仅接受了PTX。PTX术后，9例患者均在中位时间18个月（范围7-84个月）后复发，而PTX+HTX术后只有1例患者复发。PTX术后因复发中位需要进行3次（范围2-18次）再次手术，但PTX+HTX术后只有1例患者需要接受2次复发手术（p<0.001）。PTX+HTX术后的无复发生存期显著长于PTX术后（143个月对18个月，p=0.01），而两组在中位随访107.5个月后的总生存期无显著差异。
如果临床上怀疑有PC，应进行整块切除以延长无复发生存期并避免再次手术。
