Association of preoperative risk factors with therapeutic outcomes in primary hyperparathyroidism: A multivariate analysis of imaging and PTH-Calcium-Phosphate metabolic parameters in 164 cases.

IF 2.2
Nuan Li, Zishi Huang, Junwei Huang, Wei Guo, Xiaohong Chen, Qi Zhong, Jugao Fang, Yang Zhang, Zhigang Huang
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引用次数: 0

Abstract

Objective: This study aimed to identify independent risk factors associated with pathological subtypes, disease progression, and adverse outcomes in Primary hyperparathyroidism (PHPT) by analyzing clinical characteristics, thereby informing individualized therapeutic strategies.

Methods: A retrospective analysis was conducted on 164 PHPT patients treated at Beijing Tongren Hospital from May 2009 to December 2024. The analysis encompassed demographic data, preoperative evaluations, surgical details, histopathological reports, and postoperative metabolic parameters.

Results: PHPT predominantly affected females, with 84.1% of cases diagnosed incidentally during routine examinations. Preoperative ultrasonography and radionuclide imaging demonstrated high diagnostic accuracy for lesion localization (97.4% and 75.4%, respectively). Parathyroidectomy effectively normalized serum calcium, Phosphate, and parathyroid hormone (PTH) levels (P < .001). However, delayed postoperative PTH recovery correlated with advanced age (P = .038), elevated preoperative PTH and calcium levels (P < .001), and larger lesion size (> 3 cm, P < .001). Among patients with preoperative hypercalcemia, male sex (p = .039) and relatively lower baseline serum calcium levels (p = .004), combined with baseline hypophosphatemia (p = .013), were associated with an increased risk of transient or permanent postoperative hypoparathyroidism. Benign solitary adenomas showed an 8.695-fold higher treatment efficacy than malignant lesions. Preoperative phosphate levels (P = .037) and lesion size (P = .037) emerged as discriminative predictors for pathological subtypes, while severe preoperative hypophosphatemia independently indicated poor therapeutic outcomes. Smaller lesions correlated with better postoperative calcium-phosphate recovery, whereas preoperative hypercalcemia and larger lesion volume significantly influenced PTH improvement magnitude (P < .001).

Conclusion: Our findings affirmed parathyroidectomy's central role in PHPT management, highlighting substantial differences in treatment responses between benign and malignant cases. The study establishes a clinical decision-making framework combining preoperative imaging volumetry with serum PTH-calcium-phosphate profiling, enhancing pathological differentiation, guiding surgical planning, and predicting postoperative recovery trajectories. These insights enable more tailored therapeutic approaches, though validation through multicenter prospective studies remains essential for refining prognostic models and optimizing treatment protocols.

原发性甲状旁腺功能亢进术前危险因素与治疗结果的关系:164例影像学和甲状旁腺素-磷酸钙代谢参数的多因素分析
目的:本研究旨在通过分析原发性甲状旁腺功能亢进(PHPT)的临床特征,确定与病理亚型、疾病进展和不良结局相关的独立危险因素,从而为个体化治疗策略提供信息。方法:对2009年5月至2024年12月北京同仁医院收治的164例PHPT患者进行回顾性分析。分析包括人口统计数据、术前评估、手术细节、组织病理学报告和术后代谢参数。结果:PHPT以女性为主,84.1%的病例是在常规检查中偶然发现的。术前超声和核素显像对病变定位的诊断准确率较高(分别为97.4%和75.4%)。甲状旁腺切除术有效地正常化了血清钙、磷酸盐和甲状旁腺激素(PTH)水平(p3cm, P)。结论:我们的研究结果证实了甲状旁腺切除术在PHPT治疗中的核心作用,突出了良性和恶性病例治疗反应的实质性差异。本研究建立了一种将术前成像容积法与血清pth -磷酸钙谱相结合的临床决策框架,加强病理鉴别,指导手术计划,预测术后恢复轨迹。尽管通过多中心前瞻性研究的验证对于完善预后模型和优化治疗方案仍然至关重要,但这些见解使治疗方法更有针对性。
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