意大利多中心病例系列中甲状旁腺非典型腺瘤和癌的复发率和死亡率。
Recurrence and mortality rate in an Italian multi-center case series of parathyroid atypical adenomas and carcinomas.
机构信息
Division of Endocrinology, Diabetology and Metabolic Diseases, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin - Cso Dogliotti, Turin, Italy.
Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin - Via Genova, Turin, Italy.
出版信息
Front Endocrinol (Lausanne). 2023 May 8;14:1158474. doi: 10.3389/fendo.2023.1158474. eCollection 2023.
INTRODUCTION
There are few data regarding the clinical outcome of patients with parathyroid carcinoma (PC) and atypical adenoma (AA) after surgery. Aim of our study was to investigate disease recurrence and mortality rate as well as their predictors in a series of patients with PC or AA.
METHODS
Clinical and biochemical parameters, histological features, incidence of disease recurrence and mortality rate were retrospectively assessed in 39 patients (51% males, mean age 56.2 ± 17.2 years) diagnosed with PC (n=24) or AA (n=15) and followed up for 6.8 ± 5.0 years after surgery.
RESULTS
No differences in baseline characteristics were registered between the two groups, except for higher KI67 values in PC than AA (6.9 ± 3.9% vs 3.4 ± 2.1%, p<0.01). Eight patients (21%) experienced recurrence after a mean follow-up of 5.1 ± 2.7 years, with higher relapse rate in PC than AA (25% vs 13%), though this difference did not reach statistical significance. Mortality rate was 10% in the whole sample, without significant differences between PC and AA. Relapsing cases had been undergone the most extensive surgery more frequently and they had a higher mortality rate in comparison to non relapsing patients (38% vs 6% and 38% vs 3%, respectively, p<0.03 for both). In comparison to survivors, deceased patients were submitted to the most extensive surgery more frequently (50% vs 9%), they were older (74.8 ± 4.6 vs 53.2 ± 16.3 years), and they had higher KI67 values (11.7 ± 4.9 vs 4.8 ± 2.8, p<0.03 for all comparisons).
CONCLUSIONS
During seven-year follow-up after surgery, no significant differences in recurrence and mortality rate were observed between PC and AA patients. Death was associated with disease relapse, older age and higher KI67 values. These findings suggest a similar and careful long-term follow-up in both parathyroid tumors, especially in older patients, and emphasize the need of further studies in large cohorts to throw light on this crucial clinical issue.
简介
关于甲状旁腺癌（PC）和非典型腺瘤（AA）患者手术后的临床转归数据较少。本研究旨在调查一系列 PC 或 AA 患者手术后疾病复发和死亡率及其预测因素。
方法
回顾性评估了 39 例（男性 51%，平均年龄 56.2 ± 17.2 岁）PC（n=24）或 AA（n=15）患者的临床和生化参数、组织学特征、疾病复发率和死亡率，这些患者在手术后随访 6.8 ± 5.0 年。
结果
两组间基线特征无差异，除了 PC 患者的 KI67 值高于 AA（6.9 ± 3.9%比 3.4 ± 2.1%，p<0.01）。8 例（21%）患者在平均 5.1 ± 2.7 年的随访后出现复发，PC 患者的复发率高于 AA（25%比 13%），但差异无统计学意义。全组死亡率为 10%，PC 和 AA 之间无显著差异。复发患者较无复发患者更频繁地接受最广泛的手术，死亡率更高（38%比 6%和 38%比 3%，均 p<0.03）。与幸存者相比，死亡患者更频繁地接受最广泛的手术（50%比 9%），年龄更大（74.8 ± 4.6 岁比 53.2 ± 16.3 岁），KI67 值更高（11.7 ± 4.9 比 4.8 ± 2.8，所有比较均 p<0.03）。
结论
在手术后 7 年的随访中，PC 和 AA 患者的复发率和死亡率无显著差异。死亡与疾病复发、年龄较大和 KI67 值较高有关。这些发现表明，在这两种甲状旁腺肿瘤中，尤其是在老年患者中，需要进行类似的、仔细的长期随访，并强调需要在更大的队列中进行进一步的研究，以阐明这一关键的临床问题。
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