Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Ann Surg Oncol. 2024 Oct;31(10):6865-6874. doi: 10.1245/s10434-024-15611-3. Epub 2024 Jun 15.
Distant metastatic parathyroid carcinoma (DM-PC) is a rare but often lethal entity with limited data about prognostic indicators. We sought to investigate the risk factors, patterns, and outcomes of DM-PC.
In this observational cohort study, 126 patients who underwent surgery for PC at a tertiary referral center from 2010 to 2023 were enrolled, among whom 38 had DMs. Univariate and multivariate Cox regression analyses were used to assess the effects of prognostic factors on DM.
The cumulative incidence of DM was 14.1%, 33.8%, and 66.9% at 5, 10, and 20 years in the duration of disease course, respectively. DM-PC patients suffered a worse 5-year overall survival of 37.1% compared with 89.8% in the non-DM patients (p < 0.001). DM-PC patients also suffered more previous operations (p < 0.001), higher preoperative serum calcium (p<0.001) and parathyroid hormone (PTH) levels (p < 0.001), lower frequencies of R0 resection (p < 0.001), higher rates of pathological vascular invasion (p = 0.020), thyroid infiltration (p = 0.027), extraglandular extension (p = 0.001), upper aerodigestive tract (UAT) invasion (p < 0.001), and lymph node metastasis (p < 0.001). Multivariate Cox regression revealed that non-R0 resection (HR 6.144, 95% CI 2.881-13.106, p < 0.001), UAT invasion (HR 3.718, 95% CI 1.782-7.756, p < 0.001), and higher preoperative PTH levels (HR 1.001, 95% CI 1.000-1.001, p = 0.012) were independent risk factors of DM.
Upper aerodigestive tract invasion and higher preoperative PTH levels might be risk factors for possible metastatic involvement of PC. R0 resection and closer surveillance should be considered in such cases to minimize the risk of DM and to optimize patient care.
远处转移性甲状旁腺癌（DM-PC）是一种罕见但常致命的实体瘤，关于其预后指标的数据有限。我们旨在研究 DM-PC 的风险因素、模式和结局。
在这项观察性队列研究中，纳入了 2010 年至 2023 年期间在一家三级转诊中心接受甲状旁腺癌手术的 126 名患者，其中 38 名患者患有远处转移。使用单变量和多变量 Cox 回归分析来评估预后因素对 DM 的影响。
在疾病持续时间方面，DM 的累积发生率分别为 5 年时的 14.1%、10 年时的 33.8%和 20 年时的 66.9%。与非 DM 患者的 5 年总生存率 89.8%相比，DM-PC 患者的 5 年总生存率更差，为 37.1%（p<0.001）。DM-PC 患者还经历了更多的先前手术（p<0.001），更高的术前血清钙（p<0.001）和甲状旁腺激素（PTH）水平（p<0.001），更低的 R0 切除率（p<0.001），更高的病理性血管侵犯率（p=0.020），甲状腺浸润率（p=0.027），腺体外扩展率（p=0.001），上呼吸道侵犯率（p<0.001）和淋巴结转移率（p<0.001）。多变量 Cox 回归显示，非 R0 切除（HR 6.144，95%CI 2.881-13.106，p<0.001）、上呼吸道侵犯（HR 3.718，95%CI 1.782-7.756，p<0.001）和较高的术前 PTH 水平（HR 1.001，95%CI 1.000-1.001，p=0.012）是 DM 的独立危险因素。
上呼吸道侵犯和较高的术前 PTH 水平可能是 PC 发生远处转移的危险因素。在这种情况下，应考虑 R0 切除和更密切的监测，以最大程度地降低 DM 的风险并优化患者的治疗。
