终末期肾病（ESRD）患者甲状旁腺癌的队列研究。

Cohort review of patients with parathyroid cancer in End Stage Renal Disease (ESRD).

机构信息

Department of Surgery, Yong Loo Lin School of Medicine, Medical Drive, Singapore, Singapore.

Division of Endocrine Surgery, National University Hospital Health System, Lower Kent Ridge Road, Singapore, Singapore.

出版信息

Langenbecks Arch Surg. 2024 Oct 8;409(1):300. doi: 10.1007/s00423-024-03496-5.

DOI:10.1007/s00423-024-03496-5

PMID:39377972

Abstract

BACKGROUND AND HYPOTHESIS

Parathyroid carcinoma (PTTC) is a rare malignant endocrine tumor seen in up to 1-2% of all cases of primary hyperparathyroidism. However, incidence of parathyroid carcinoma in renal hyperparathyroidism is a rare phenomenon. We aimed to evaluate the outcomes of PTTC in renal hyperparathyroidism published in the literature.

METHODS

Cohort review of parathyroid cancer cases reported in Medline (via PubMed), COCHRANE and EMBASE between the period 1985 - 2023 in patients with renal hyperparathyroidism.

RESULTS

A total of 48 patients (20 M: 28F), with a mean age of 49.8 (± 11.7 SD: range 20-75) years. Dialysis vintage was for a period of 8.9 (± 7.2; range 6 months to 40 years). The mean preoperative values were as follows: serum corrected calcium-2.87 IQR 2.56-3.01), PTH - 221.8 (IQR 86.6 -257.2 pmol/L) and serum phosphate - 2.07 (IQR 1.72-2.28) mmol/L. Preoperative imaging was in the form of ultrasound of the neck in 21 of 48 (44%), MIBI scan in 27/48 (56%), contrast enhanced computerized tomography in 14/48 (29%) and MRI neck in 1/48 (2%). The mean size of the cancer was 2.7 (± 1.35) cm and weight of the gland ranged between 0.9 to 4.98 g. 18/48 (37%) patients underwent a total parathyroidectomy and 30/48 (63%) had subtotal parathyroidectomy. En bloc excision of the tumour along with the thyroid along and central compartment lymph nodes was only performed in 12/48 (25%), of whom 9 (19%) had it performed at index surgery, whereas in the rest was done for persistent or recurrent disease. After a mean follow up of 34 months, 14 (29%) had local recurrence, 1 (2%) had distant metastasis to the skeletal system, and 12 (25%) to the lungs. Cohort mortality was 6 (13%) due to refractory hypercalcemia.

CONCLUSIONS

Parathyroid carcinoma in renal hyperparathyroidism is rare but when encountered, en bloc excision with parathyroidectomy provides the best chance of cure. Recurrences can be difficult to treat but may be needed to treat intractable hypercalcaemia.

摘要

背景与假设

甲状旁腺癌（PTTC）是一种罕见的恶性内分泌肿瘤，在所有原发性甲状旁腺功能亢进症患者中占 1-2%。然而，甲状旁腺癌在肾性甲状旁腺功能亢进症中的发病率是罕见的。我们旨在评估文献中报道的肾性甲状旁腺功能亢进症中甲状旁腺癌的治疗结果。

方法

对 1985 年至 2023 年间在 Medline（通过 PubMed）、COCHRANE 和 EMBASE 中报告的甲状旁腺癌病例进行队列研究，患者患有肾性甲状旁腺功能亢进症。

结果

共 48 例患者（20 例男性：28 例女性），平均年龄 49.8（±11.7 SD：范围 20-75）岁。透析时间为 8.9（±7.2；范围 6 个月至 40 年）。术前平均指标如下：血清校正钙-2.87 IQR 2.56-3.01），PTH-221.8（IQR 86.6-257.2 pmol/L）和血清磷酸盐-2.07（IQR 1.72-2.28）mmol/L。术前影像学检查形式为 48 例中的 21 例（44%）颈部超声、27/48（56%）MIBI 扫描、14/48（29%）增强计算机断层扫描和 1/48（2%）颈部 MRI。肿瘤的平均大小为 2.7（±1.35）cm，腺体重量在 0.9 至 4.98g 之间。18/48（37%）例患者接受了甲状旁腺全切除术，30/48（63%）例患者接受了甲状旁腺次全切除术。仅在 12/48（25%）例中进行了肿瘤与甲状腺和中央隔淋巴结的整块切除，其中 9 例（19%）在指数手术中进行，而在其余病例中，是为了治疗持续性或复发性疾病。平均随访 34 个月后，14 例（29%）发生局部复发，1 例（2%）发生远处骨骼系统转移，12 例（25%）发生肺部转移。队列死亡率为 6（13%），由于难治性高钙血症所致。