Hu Ya, Cui Ming, Chang Xiaoyan, Wang Ou, Chen Tianqi, Xiao Jinheng, Wang Mengyi, Hua Surong, Liao Quan
Department of General Surgery, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Cancers (Basel). 2022 Aug 19;14(16):4004. doi: 10.3390/cancers14164004.
Parathyroid carcinoma (PC) is a rare endocrine malignancy with poor outcomes. Over 60% of PC patients experience repeated disease recurrence or metastasis. The significance of cervical lymph node dissection (LND) for PC remains inconclusive.
PC patients diagnosed at Peking Union Medical College Hospital between 1992 and 2021 were reviewed retrospectively. Clinical data, initial tumor histological staging, parafibromin histochemical staining results, Ki67 index, gene mutation status and outcome information were collected systemically. The risk factors for recurrence and lymph node or distant metastasis were explored.
Sixty-eight PC patients receiving LND were enrolled. Cervical lymph node metastasis was identified in 19.4% of patients at initial surgery and 25.0% of patients including reoperations for recurrences. The independent risk factor for PC recurrence was a Ki67 index ≥ 5% (HR4.41, 95% confidence interval (CI)1.30-14.95, = 0.017). Distant metastasis was an independent prognostic factor for PC patient overall survival (HR 5.44, 95% CI 1.66-17.82, = 0.005). High-risk Schulte staging ( = 0.021) and abnormalities ( = 0.012) were risk factors for cervical lymph node metastasis.
Most PCs were slow-growing, but lymph node metastasis was not rare. For patients planning to undergo remedial surgery after previous local resection of PC, central LND is suggested for tumors with high-risk Schulte staging or abnormalities.
甲状旁腺癌（PC）是一种罕见的内分泌恶性肿瘤，预后较差。超过60%的PC患者会经历疾病复发或转移。颈部淋巴结清扫术（LND）对PC的意义仍无定论。
回顾性分析1992年至2021年在北京协和医院诊断的PC患者。系统收集临床资料、初始肿瘤组织学分期、副纤维蛋白组织化学染色结果、Ki67指数、基因突变状态和预后信息。探讨复发、淋巴结或远处转移的危险因素。
纳入68例行LND的PC患者。初次手术时19.4%的患者发现颈部淋巴结转移，包括复发再手术的患者中25.0%发现颈部淋巴结转移。PC复发的独立危险因素是Ki67指数≥5%（HR 4.41，95%置信区间（CI）1.30 - 14.95，P = 0.017）。远处转移是PC患者总生存的独立预后因素（HR 5.44，95% CI 1.66 - 17.82，P = 0.005）。高危Schulte分期（P = 0.021）和RET异常（P = 0.012）是颈部淋巴结转移的危险因素。
大多数PC生长缓慢，但淋巴结转移并不罕见。对于既往PC局部切除后计划行补救性手术的患者，对于高危Schulte分期或RET异常的肿瘤，建议行中央LND。
