Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma

Abstract

Background: Parathyroid carcinoma (PC) is a rare endocrine malignancy with poor outcomes. Over 60% of PC patients experience repeated disease recurrence or metastasis. The significance of cervical lymph node dissection (LND) for PC remains inconclusive. Methods: PC patients diagnosed at Peking Union Medical College Hospital between 1992 and 2021 were reviewed retrospectively. Clinical data, initial tumor histological staging, parafibromin histochemical staining results, Ki67 index, CDC73 gene mutation status and outcome information were collected systemically. The risk factors for recurrence and lymph node or distant metastasis were explored. Results: Sixty-eight PC patients receiving LND were enrolled. Cervical lymph node metastasis was identified in 19.4% of patients at initial surgery and 25.0% of patients including reoperations for recurrences. The independent risk factor for PC recurrence was a Ki67 index ≥ 5% (HR4.41, 95% confidence interval (CI)1.30–14.95, p = 0.017). Distant metastasis was an independent prognostic factor for PC patient overall survival (HR 5.44, 95% CI 1.66–17.82, p = 0.005). High-risk Schulte staging (p = 0.021) and CDC73 abnormalities (p = 0.012) were risk factors for cervical lymph node metastasis. Conclusion: Most PCs were slow-growing, but lymph node metastasis was not rare. For patients planning to undergo remedial surgery after previous local resection of PC, central LND is suggested for tumors with high-risk Schulte staging or CDC73 abnormalities.

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

“…On the other hand, some authors indicated that more advanced disease (such as large tumor size, high-risk Schulte staging, and CDC73 abnormalities) represented a greater incidence of lymph node metastasis in PC patients, which was a risk factor of disease recurrence after surgery and thus worsened survival ( 9 , 17 ). So, we furtherly wonder whether there is a subset of PC patients (e.g., patients with advanced disease) who may benefit from the prognostic value of a central LND as a component of their initial surgery.…”

“…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.…”

Diagnosis and management of parathyroid carcinoma: a state-of-the-art review

“…Emerging evidence from Hu et al (2022), Krupinova et al (2021) and Wang et al (2022), highlights the potential diagnostic role of microRNA-(miRNA) and microDNA-(miDNA) molecule expression in PC tumours. MiRNAs play an important role in the occurrence and metastasis of tumours as they are involved in almost all biological processes and affect cell proliferation, differentiation, adhesion, migration, invasion and apoptosis (Verdelli & Corbetta 2017).…”

Diagnostic, Prognostic, and Predictive Role of Ki67 Proliferative Index in Neuroendocrine and Endocrine Neoplasms: Past, Present, and Future

“…A diagnostic nomogram including five biomarkers (parafibromin, Rb, Ki67, PGP9.5, and galectin 3) has been proposed but Ki67 did not show as good performance as the staining for parafibromin in distinguishing adenoma from carcinoma [63]. In addition to its diagnostic role, Ki67 index has also been explored as a prognostic marker in parathyroid tumors, without definitive results [64,65]. For these reasons, Ki67 it is not currently included in the diagnostic algorithm of parathyroid neoplasm for the differential diagnosis between parathyroid adenoma and carcinoma, although it may give an overview on the proliferative activity of the tumor.…”