Department of Medicine, Harvard Medical School, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, 02138, USA.
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Calcif Tissue Int. 2024 Jul;115(1):1-13. doi: 10.1007/s00223-024-01219-y. Epub 2024 May 21.
This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved from PubMed and Embase databases from inception to November 2023 using search strategy consisting of terms for "Primary hyperparathyroidism" and "Malignant neoplasm". Eligible study must report prevalence of malignant neoplasm among patients with PHPT or compare the risk of malignant neoplasm between patients with PHPT and comparators. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method.A total of 11,926 articles were identified. After two rounds of systematic review, 50 studies were included. The meta-analysis revealed that pooled prevalence rates of overall cancer was 0.19 (95%CI: 0.13-0.25; I 94%). The two most prevalent types of malignancy among patients with PHPT ware papillary thyroid cancer (pooled prevalence: 0.07; 95%CI: 0.06-0.08; I 85%) and breast cancer (pooled prevalence: 0.05; 95%CI: 0.03-0.07; I 87%). Subgroup analysis of studies focusing on patients undergoing parathyroidectomy reported a fourfold higher prevalence of papillary thyroid cancer than the remaining studies (0.08 versus 0.02). The meta-analysis of cohort studies found a significant association between PHPT and overall cancer with the pooled risk ratio of 1.28 (95%CI: 1.23-1.33; I 66.9%).We found that the pooled prevalence of malignant neoplasm in PHPT was 19%, with papillary thyroid cancer and breast cancer being the most prevalent types. The meta-analysis of cohort studies showed that patient with PHPT carried an approximately 28% increased risk of malignancy.
本研究旨在评估原发性甲状旁腺功能亢进症（PHPT）患者恶性肿瘤的患病率和风险。通过检索 PubMed 和 Embase 数据库，从建库至 2023 年 11 月，使用包含“原发性甲状旁腺功能亢进症”和“恶性肿瘤”的检索策略，检索到了潜在的合格研究。合格的研究必须报告 PHPT 患者中恶性肿瘤的患病率，或比较 PHPT 患者与对照者恶性肿瘤的风险。从每项研究中提取点估计值和标准误差，并使用通用倒数方差法进行合并。共识别出 11926 篇文章。经过两轮系统评价，纳入了 50 项研究。荟萃分析显示，总体癌症的合并患病率为 0.19（95%CI：0.13-0.25；I 94%）。PHPT 患者中最常见的两种恶性肿瘤是甲状腺乳头状癌（合并患病率：0.07；95%CI：0.06-0.08；I 85%）和乳腺癌（合并患病率：0.05；95%CI：0.03-0.07；I 87%）。对关注甲状旁腺切除术患者的研究进行亚组分析，发现甲状腺乳头状癌的患病率是其余研究的四倍（0.08 与 0.02）。队列研究的荟萃分析发现，PHPT 与总体癌症之间存在显著关联，合并风险比为 1.28（95%CI：1.23-1.33；I 66.9%）。我们发现，PHPT 患者恶性肿瘤的合并患病率为 19%，甲状腺乳头状癌和乳腺癌是最常见的类型。队列研究的荟萃分析表明，PHPT 患者发生恶性肿瘤的风险增加了约 28%。
