Department of Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Ann Surg Oncol. 2021 Jan;28(1):502-511. doi: 10.1245/s10434-020-08825-8. Epub 2020 Jul 13.
The routine use of external beam radiotherapy (EBRT) is not recommended for parathyroid carcinoma (PC). However, case series have demonstrated a potential benefit in preventing local recurrence with EBRT. We aimed to characterize the patient population treated with EBRT and identify any impact of EBRT on overall survival (OS) in parathyroid carcinoma.
Patients who underwent surgery for PC from 2004 to 2016 were identified from the National Cancer Database. Clinicopathologic variables and OS were compared between patients based on treatment with EBRT. Multivariable logistic and Cox regression models were performed with propensity scores and inverse-probability-weighting (IPW) adjustment to reduce treatment-selection bias in the OS analysis.
A total of 885 patients met the inclusion criteria, with 126 (14.2%) undergoing EBRT. Demographics were similar between the two cohorts (EBRT vs. no EBRT). However, patients treated with EBRT had a higher frequency of regionally extensive disease, nodal metastases, and residual microscopic disease (all p < 0.05). On multivariable analysis, Black race, regional tumor extension, nodal metastasis, and treatment at an urban facility were independently associated with EBRT. The 5-year OS was 85.3% with a median follow-up of 60.8 months. EBRT was not associated with a difference in OS in crude, multivariable, or IPW models. More importantly, 10.5% of patients with completely resected localized disease (M0, N0 or Nx) underwent EBRT without a benefit in OS (p = 0.183).
EBRT is not associated with any survival benefit in the treatment of PC. Therefore, it may be overutilized, particularly in patients with localized disease and complete surgical resection.
常规使用外照射放疗（EBRT）并不推荐用于甲状旁腺癌（PC）。然而，病例系列研究表明 EBRT 在预防局部复发方面具有潜在益处。我们旨在描述接受 EBRT 治疗的患者人群，并确定 EBRT 对 PC 患者总生存（OS）的任何影响。
从国家癌症数据库中确定了 2004 年至 2016 年因 PC 接受手术治疗的患者。根据 EBRT 的治疗情况，比较了患者的临床病理变量和 OS。采用倾向评分和逆概率加权（IPW）调整进行多变量逻辑和 Cox 回归模型，以减少 OS 分析中的治疗选择偏倚。
共有 885 名患者符合纳入标准，其中 126 名（14.2%）接受了 EBRT。两组患者的人口统计学特征相似（EBRT 与无 EBRT）。然而，接受 EBRT 治疗的患者区域性广泛疾病、淋巴结转移和残留微观疾病的发生率更高（均 P<0.05）。多变量分析显示，黑人种族、区域性肿瘤扩展、淋巴结转移和在城市医疗机构治疗与 EBRT 独立相关。5 年 OS 为 85.3%，中位随访时间为 60.8 个月。EBRT 与 OS 无差异，无论是在粗模型、多变量模型还是在 IPW 模型中。更重要的是，10.5%的完全切除局限性疾病（M0、N0 或 Nx）患者接受了 EBRT，但 OS 无获益（P=0.183）。
EBRT 治疗 PC 并不增加生存获益。因此，它可能被过度使用，尤其是在局部疾病和完全手术切除的患者中。
