Wang Mingjun, Wei Tao, Gong Rixiang, Zhu Jingqiang, Li Zhihui, Gong Yanping
Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2024 Apr 29;13(4):500-511. doi: 10.21037/gs-23-501. Epub 2024 Apr 9.
Surgery is the only curative treatment strategy for parathyroid carcinoma (PC). However, the optimal extent of surgery remains uncertain, particularly regarding whether routine central lymph node dissection (LND) confers a survival advantage to patients with PC. This study aimed to evaluate the prognostic value of LND in PC patients.
Patients diagnosed with PC between 2004 and 2018 were identified in the Surveillance, Epidemiology, and End Results (SEER)-18 registries. With inclusion and exclusion criteria, a total of 338 patients were included as cohort 1 to describe the characteristics of PC, while 215 patients were selected as cohort 2 to assess the effect of LND on cancer-specific survival (CSS). Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors associated with CSS. Propensity score matching (PSM) was performed to adjust for potential confounding variables. The prognostic value of LND was further analyzed in subgroups stratified by predictors associated with CSS.
The 5- and 10-year CSS were 94.4% and 87.9% respectively in cohort 1. LND failed to significantly improve CSS in the entire cohort 2 and the PSM cohort 2. Large tumor size (>40 mm) and distant metastasis were independently associated with poor CSS. Subgroup analyses revealed that LND was not significantly associated with improved CSS in patients with aggressive PC, such as those with a tumor size greater than 40 mm. Unexpectedly, LND may compromise CSS in patients with distant disease (P=0.03).
PC is a rare and indolent endocrine malignancy. The presence of large tumors and distant metastases are independent predictors of poor CSS. Routine central LND as part of initial surgery does not significantly improve CSS in PC patients, even for those with large tumors, lymph node metastasis, or distant disease.
手术是甲状旁腺癌（PC）唯一的治愈性治疗策略。然而，手术的最佳范围仍不确定，特别是关于常规中央淋巴结清扫术（LND）是否能为PC患者带来生存优势。本研究旨在评估LND对PC患者的预后价值。
在监测、流行病学和最终结果（SEER）-18登记处中识别出2004年至2018年期间诊断为PC的患者。根据纳入和排除标准，共纳入338例患者作为队列1来描述PC的特征，同时选择215例患者作为队列2来评估LND对癌症特异性生存（CSS）的影响。使用单变量和多变量Cox比例风险回归模型来识别与CSS相关的独立危险因素。进行倾向评分匹配（PSM）以调整潜在的混杂变量。在按与CSS相关的预测因素分层的亚组中进一步分析LND的预后价值。
队列1中5年和10年的CSS分别为94.4%和87.9%。LND未能在整个队列2和PSM队列2中显著改善CSS。肿瘤体积大（>40mm）和远处转移与不良CSS独立相关。亚组分析显示，在侵袭性PC患者中，如肿瘤大小大于40mm的患者，LND与CSS改善无显著相关性。出乎意料的是，LND可能会损害远处疾病患者的CSS（P=0.03）。
PC是一种罕见且惰性的内分泌恶性肿瘤。大肿瘤和远处转移的存在是不良CSS的独立预测因素。作为初始手术一部分的常规中央LND并不能显著改善PC患者的CSS，即使对于那些有大肿瘤、淋巴结转移或远处疾病的患者也是如此。
