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

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-10-08 DOI:10.1007/s00423-024-03496-5

Victoria Zheng, James Lee, Rajeev Parameswaran

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引用次数: 0

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.

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终末期肾病（ESRD）甲状旁腺癌患者队列回顾。

背景和假设：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病例中的发病率高达1%-2%。然而，肾性甲状旁腺功能亢进症中甲状旁腺癌的发病率却非常罕见。我们的目的是评估文献中发表的肾性甲状旁腺功能亢进症中PTTC的结果：对1985-2023年间Medline（通过PubMed）、COCHRANE和EMBASE中报道的肾性甲状旁腺功能亢进症患者甲状旁腺癌病例进行队列回顾：共有 48 名患者（20 名男性：28 名女性），平均年龄为 49.8 岁（± 11.7 SD：20-75 岁）。透析年限为 8.9 年（± 7.2；范围为 6 个月至 40 年）。术前平均值如下：血清校正钙-2.87 IQR 2.56-3.01），PTH-221.8（IQR 86.6 -257.2 pmol/L），血清磷酸盐-2.07（IQR 1.72-2.28）mmol/L。48 例患者中有 21 例（44%）接受了颈部超声波检查，27/48 例（56%）接受了 MIBI 扫描，14/48 例（29%）接受了造影剂增强型计算机断层扫描，1/48 例（2%）接受了颈部磁共振成像检查。18/48（37%）名患者接受了甲状旁腺全切除术，30/48（63%）名患者接受了甲状旁腺次全切除术。只有12/48（25%）的患者接受了肿瘤连同甲状腺和中央区淋巴结的整体切除术，其中9人（19%）是在首次手术时进行的，其余患者则是在病情持续或复发时进行的。平均随访34个月后，14例（29%）局部复发，1例（2%）远处转移至骨骼系统，12例（25%）转移至肺部。因难治性高钙血症导致的队列死亡率为6例（13%）：结论：肾性甲状旁腺功能亢进症中的甲状旁腺癌非常罕见，但一旦发生，通过甲状旁腺切除术进行全切可获得最佳治愈效果。复发的甲状旁腺癌可能很难治疗，但可能需要治疗难治性高钙血症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.