Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Ann Surg Oncol. 2022 Feb;29(2):1208-1215. doi: 10.1245/s10434-021-10962-7. Epub 2021 Oct 25.
Parathyroid carcinoma (PC) is a rare malignancy that is difficult to eradicate completely after recurrence. We assessed the efficiency of extended en bloc resection (EEBR) in the management of recurrent or persistent PC.
In this observational cohort study, 31 patients who underwent reoperations for recurrent or persistent PC were enrolled after 2-9 surgeries by other medical teams. EEBRs, which provided the oncologic resection by removing all possible tumor-bearing scar tissues, were adopted in 25 patients. The other 6 with gross infiltration into the upper aerodigestive tract (UAT) underwent less radical procedures for unwillingness to sacrifice laryngeal function.
The 5-year overall survival (OS) rate after EEBR was 59.6% compared with 16.7% after less radical procedures, with an improved median expected survival time of 90.0 months compared with 13.0 months after local excision. EEBR exhibited a favorable local control of relapses in 84.0% of patients after a median follow-up period of 27.0 months, 40.0% even achieved disease-free survival, although 56.0% had subsequent distant metastases (DMs) and suffered a worse 5-year OS of 36.7% in contrast with 100.0% in the absence of DM (p = 0.011). UAT invasion, rather than age, number of previous operations, or preoperative PTH levels, was the unique independent factor associated with both DM (HR = 5.466, p = 0.006) and mortality (HR = 7.606, p = 0.011).
EEBRs provide better outcomes than other conventional surgical approaches and might offer a second chance of cure for patients with recurrent or persistent PC in the absence of DM.
甲状旁腺癌（PC）是一种罕见的恶性肿瘤，复发后很难彻底根除。我们评估了扩大整块切除术（EEBR）在复发性或持续性 PC 管理中的效率。
在这项观察性队列研究中，31 名患者在其他医疗团队进行了 2-9 次手术后，因复发性或持续性 PC 再次接受手术。25 名患者采用 EEBR，通过切除所有可能的肿瘤负荷组织提供肿瘤切除。另外 6 名因不愿牺牲喉功能而出现大体浸润上呼吸道（UAT）的患者接受了不那么激进的手术。
EEBR 后 5 年总生存率（OS）为 59.6%，而激进程度较低的手术为 16.7%，中位预期生存时间从局部切除后的 13.0 个月延长至 90.0 个月。在中位随访 27.0 个月后，EEBR 对 84.0%的患者复发有较好的局部控制，40.0%甚至实现无病生存，尽管 56.0%发生了远处转移（DM），5 年 OS 较差，为 36.7%，而无 DM 时为 100.0%（p = 0.011）。UAT 侵犯，而不是年龄、之前手术的次数或术前甲状旁腺激素水平，是与 DM（HR = 5.466，p = 0.006）和死亡率（HR = 7.606，p = 0.011）相关的唯一独立因素。
EEBR 比其他常规手术方法提供更好的结果，并且可能为无 DM 的复发性或持续性 PC 患者提供第二次治愈的机会。
