A Nomogram Predicting the Overall Survival and Cancer-Specific Survival in Patients with Parathyroid Cancer: A Retrospective Study

Abstract

PurposeThis study aimed to explore a visual model for predicting the prognosis of patients with parathyroid carcinoma (PC) and analyze related biochemistries in different groups of stage.MethodsThe training dataset of 342 patients with PC was obtained from the Surveillance, Epidemiology, and End Results (SEER) database, and the validation dataset included 59 patients from The First Affiliated Hospital of Zhengzhou University. Univariate and multivariate Cox regression analyses were performed to evaluate significant independent prognostic factors. Based on those factors, nomograms and Web-based probability calculators were constructed to evaluate the overall survival (OS) and the cancer-specific survival (CSS) at 3, 5, and 8 years. The concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram in the training set and validation set. Moreover, biochemistries from the validation set were retrospectively analyzed in different groups of stage by Kruskal–Wallis test.ResultsAge, marital status, tumor size, stage, lymph node status, and radiation were identified as prognostic factors of OS. In contrast, only tumor size and stage were predictive for CSS. The nomogram was developed based on these independent factors. The C-index, ROC curve, calibration curve, and DCA of the nomogram in both training and validation sets showed that the nomogram had good predictive value, stability, and clinical benefit in predicting 3-, 5-, and 8-year OS and CSS in PC patients. Among the 59 PC patients from our hospital, lower albumin (ALB) levels and higher postoperative parathyroid hormone (PTH) levels were found in patients with distant metastasis (Distant vs. Regional ALB levels: p = 0.037; Distant vs. Local ALB levels: p = 0.046; Distant vs. Regional postoperative PTH levels: p = 0.002; Distant vs. Local postoperative PTH: p = 0.002).ConclusionThe established nomogram application can provide accurate prognostics for patients with PC in the Chinese population, but it must be validated on prospectively collected real-world data.

The prognostic value of lymph node dissection in patients with parathyroid carcinoma

“…In this study, the involvement of distant organs and lymph nodes in PC patients carried a 7.3–9.3 times risk of death compared with local disease. Other prognostic factors reported in prior studies such as older age, Caucasian race, male sex, and marital status were not confirmed in this study ( 19 , 20 ). Coincidentally, both tumor size and disease progression were included in the mainstream staging system for PC patients proposed by Shaha and Shah ( 23 ).…”

“…In the current study, using X-tile program, tumor size over 40 mm was identified as the optimal cutoff predicting survival. Expectedly, distant spread has been uniformly considered a key factor affecting the prognosis of PC ( 16 , 17 , 20 , 22 ). In this study, the involvement of distant organs and lymph nodes in PC patients carried a 7.3–9.3 times risk of death compared with local disease.…”

Mediastinal Parathyroid Cancer

“…MPC meets both 3 + 3 criteria even more commonly than cervical PC ( Figure 3 b). The observation that tumour size only variably correlates with long-term disease outcomes in PC [ 15 , 86 , 87 , 88 ] equally does not subtract from the value of our observations. The purpose of the 3 + 3 rule is not long-term outcome prediction, but the pre-operative identification of malignancy with the purpose of guiding an adequate surgical approach.…”

Comparison of prognosis after partial and total surgical resection for parathyroid carcinoma: an inverse probability of treatment weighting analysis of the SEER database

“…These findings are consistent with those of previous studies ( 22 , 26 ). Previous studies on the role of marital status as a prognostic factor affecting OS in patients with PC reported inconsistent conclusions ( 24 , 26 ). This discrepancy in results may be due to differences in the criteria used in studies for the selection of patients.…”