Stage and age as distinct determinants of competing mortality in parathyroid carcinoma: a population-based analysis.

IF 2.9 3区医学 Q2 Medicine

Endocrine Pub Date : 2026-10-10 DOI:10.1007/s12020-026-04782-6

Mehmet Zafer Sabuncuoğlu, Ismail Zihni, Bilal Turan, Serdar Acar, Isa Karaca

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引用次数: 0

Abstract

Purpose: Parathyroid carcinoma is a rare endocrine malignancy in which much of the long-term morbidity relates to chronic hypercalcemia. Conventional survival analyses treat deaths from causes other than the cancer as censoring events, which can distort estimates of cause-specific risk. We applied competing-risk methodology to characterize cause-specific mortality and to determine whether distinct clinical factors differentially influence cancer-specific and cardiovascular/renal mortality.

Methods: Patients with malignant parathyroid carcinoma (primary site C75.0) were identified from the SEER Research Data, 17 Registries, November 2023 submission (2000-2021). Cause-specific, cardiovascular/renal, and other-cause deaths were defined a priori as competing events. Cumulative incidence functions were estimated using the Aalen-Johansen estimator, compared with Gray's test, and modeled with Fine-Gray subdistribution hazard regression, adjusting for age, sex, race, and stage.

Results: Among 656 patients (median follow-up, 86 months), 213 died: 61 (9.3%) from cancer-specific causes, 68 (10.4%) from cardiovascular/renal causes, and 84 (12.8%) from other causes. Cancer-specific mortality plateaued after roughly a decade (15-year cumulative incidence, 11.0%), whereas cardiovascular/renal mortality continued to rise (12.3%) and ultimately exceeded it. In multivariable Fine-Gray models, advanced (regional/distant) stage was independently associated with cancer-specific death (subdistribution hazard ratio [sHR], 3.37; 95% CI, 1.72-6.60) but not cardiovascular/renal death, whereas age ≥ 60 years was independently associated with cardiovascular/renal death (sHR, 2.43; 95% CI, 1.49-3.96) but not cancer-specific death.

Conclusions: Cancer-specific and cardiovascular/renal mortality follow distinct competing-risk trajectories in parathyroid carcinoma, with stage primarily determining cancer-specific mortality and age primarily determining cardiovascular/renal mortality. These findings support consideration of competing-risk profiles when planning long-term surveillance, including cardiovascular and renal follow-up.

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.