Clinical characteristics and treatment outcomes of parathyroid carcinoma: A retrospective review of 234?cases

Abstract

Parathyroid carcinoma (PC) is one of the rarest known types of cancer and has a moderate prognosis, with estimated 5- and 10-year overall survival rates between 78–85% and between 49–70%, respectively. To raise awareness of this disease, and to optimize its diagnosis, clinical management and prognosis, the present study retrospectively reviewed 234 cases of PC. A total of 226 cases of PC, which were archived between 1984 and 2015 in the three major databases of the Chinese population, were retrieved and pooled with the 8 cases diagnosed and treated at the Department of Thyroid Surgery of The First Hospital of Jilin University (Changchun, China) between June 2008 and December 2015. The clinicopathological features, diagnosis, surgical procedures and outcomes of these cases of PC were investigated. The review revealed that misdiagnosis has been a considerable issue, with >80% of the patients misdiagnosed prior to surgery, and the accuracy of intraoperative diagnosis based on frozen sections was only 15.04%. The use of radical resection as first-line therapy significantly improved the disease-free survival by ~8 years (log-rank, 20.956; P<0.001); and, at relapse, reoperation prolonged patient survival by ~7 years (log-rank, 35.322; P<0.001). Consistently, a Cox proportional hazards analysis indicated that radical resection as a first-line therapy reduced the risk of postoperative recurrence (P=0.030), and that reoperation following recurrence significantly improved patient survival (P=0.030). The 5- and 10-year cumulative disease-specific survival rates of the cases of PC were 83 and 67%, respectively. Notably, an increased mortality rate was observed among males with PC compared with female patients with PC. In summary, in the past 32 years (1984–2015), the majority of patients with PC have been misdiagnosed. Performing radical resection as the first-line therapy significantly reduces recurrence and improves patient survival time; and, following relapse, subsequent surgery has also been demonstrated to be an effective approach.

Pediatric Parathyroid Carcinoma: A Case Report and Review of the Literature

“…Some researchers prefer resection of the involved recurrent laryngeal nerve if the tumor cannot be dissected from the nerve completely [39]. En bloc /radical excision has been shown to be independently associated with decreased PC recurrence [40]. In spite of this knowledge, most patients undergo simple excision, which reflects the diagnostic challenges prior to initial surgery.…”

Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties

“…It is often not possible to diagnose parathyroid cancer preoperatively. If parathyroid cancer is suspected, an en bloc resection including the ipsilateral thyroid lobe and the adjacent soft tissue is motivated .…”

Simultaneous presentation of parathyroid carcinoma, papillary thyroid cancer and ACTH-independent hypercortisolism due to benign cortical adenoma

“…Parathyroid cancer is rare and often suspected intraoperatively by an experienced surgeon. Intraoperative suspicion of parathyroid cancer should lead to an en-bloc resection (including ipsilateral lobectomy ± level VI dissection) even in the absence of a definitive histological diagnosis, as surgery is currently the only effective treatment and complete resection at the first operation is associated with improved disease-free survival and lower recurrence rates 23. A detailed discussion in a multidisciplinary setting is essential for optimum management of these patients.…”