Ramonell Kimberly M, Liou Rachel, Zheng Xinyan, Song Zhixing, Lee James A, Sedrakyan Art, Chen Herbert
University of Pittsburgh Medical Center, Department of Surgery, Division of Surgical Oncology, Pittsburgh, PA.
Columbia University Medical Center, Department of Surgery, Division of Endocrine Surgery, New York, NY.
Ann Surg. 2024 Aug 23. doi: 10.1097/SLA.0000000000006508.
To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions.
Long-term, untreated primary hyperparathyroidism is associated with significant morbidity including nephrolithiasis and cardiovascular disease.
We conducted a Population-based Cohort study of New York and California state-wide data from 2000-2020. Adult patients who underwent renal stone treatment and subsequently diagnosed with primary hyperparathyroidism (pHPT) and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was prior to index stone procedure, they underwent second stone treatment within 6 months, with stage V CKD, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. Rate of renal stone retreatment and cardiovascular interventions after PTX in pHPT patients with nephrolithiasis who underwent parathyroid surgery at ≤ 2 years and >2 years after index stone procedure was measured.
We identified 2,093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (IQR 187-1477) and follow-up was 7.4 years (IQR 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR 1.59; P<0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P=0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR 1.52; P<0.01).
In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.
确定甲状旁腺手术时机是否会影响肾结石再次治疗及心血管介入治疗的风险。
长期未经治疗的原发性甲状旁腺功能亢进与包括肾结石和心血管疾病在内的显著发病率相关。
我们对2000年至2020年纽约州和加利福尼亚州的全州数据进行了一项基于人群的队列研究。纳入接受过肾结石治疗，随后被诊断为原发性甲状旁腺功能亢进（pHPT）并接受甲状旁腺切除术（PTX）的成年患者。如果PTX在首次结石手术之前进行、在6个月内接受了第二次结石治疗、患有Ⅴ期慢性肾脏病、继发性或三发性甲状旁腺功能亢进、有过肾移植或血液透析史、或有过癌症诊断，则将患者排除。测量在首次结石手术后≤2年和>2年接受甲状旁腺手术的肾结石性pHPT患者PTX后肾结石再次治疗及心血管介入治疗的发生率。
我们确定了2093例接受首次结石治疗并随后接受PTX的患者。PTX的中位时间为560天（四分位间距187 - 1477），随访时间为7.4年（四分位间距4.5 - 13.1）。将PTX推迟超过2年使肾结石再次治疗的风险增加了59%（风险比1.59；P<0.001），使发生冠心病或相关介入治疗的风险增加了118%（风险比 = 2.18；P = 0.01），并使发生总体心血管事件的风险增加了52%（风险比1.52；P<0.01）。
在有症状的pHPT中，推迟PTX会显著增加未来需要进行结石再次治疗及心脏/血管外科干预的风险。这凸显了早期手术转诊以及多学科方法对于优化pHPT治疗效果和资源利用的重要性。
