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Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma
SIMPLE SUMMARY: Parathyroid carcinoma (PC) is a rare endocrine malignancy with poor outcomes. Surgery remains the mainstay of PC treatment. However, due to the rarity of this malignancy, the optimal extent of PC surgery remains inconclusive, including whether to perform central lymph node dissection...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406600/ https://www.ncbi.nlm.nih.gov/pubmed/36010997 http://dx.doi.org/10.3390/cancers14164004 |
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author | Hu, Ya Cui, Ming Chang, Xiaoyan Wang, Ou Chen, Tianqi Xiao, Jinheng Wang, Mengyi Hua, Surong Liao, Quan |
author_facet | Hu, Ya Cui, Ming Chang, Xiaoyan Wang, Ou Chen, Tianqi Xiao, Jinheng Wang, Mengyi Hua, Surong Liao, Quan |
author_sort | Hu, Ya |
collection | PubMed |
description | SIMPLE SUMMARY: Parathyroid carcinoma (PC) is a rare endocrine malignancy with poor outcomes. Surgery remains the mainstay of PC treatment. However, due to the rarity of this malignancy, the optimal extent of PC surgery remains inconclusive, including whether to perform central lymph node dissection (LND). In the present study, we reported the patterns and predictors of cervical lymph node metastasis in PC based on a cohort of 68 PC patients. The results showed that the percentage of cervical lymph node metastasis in PC was 19.4% at initial surgery and 25.0% including reoperations for recurrencies. High-risk Schulte staging and CDC73 abnormalities were identified as risk factors for cervical lymph node metastasis. Central LND should be considered during remedial surgeries performed after previous local resection of PC for patients with high risk factors. 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. |
format | Online Article Text |
id | pubmed-9406600 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-94066002022-08-26 Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma Hu, Ya Cui, Ming Chang, Xiaoyan Wang, Ou Chen, Tianqi Xiao, Jinheng Wang, Mengyi Hua, Surong Liao, Quan Cancers (Basel) Article SIMPLE SUMMARY: Parathyroid carcinoma (PC) is a rare endocrine malignancy with poor outcomes. Surgery remains the mainstay of PC treatment. However, due to the rarity of this malignancy, the optimal extent of PC surgery remains inconclusive, including whether to perform central lymph node dissection (LND). In the present study, we reported the patterns and predictors of cervical lymph node metastasis in PC based on a cohort of 68 PC patients. The results showed that the percentage of cervical lymph node metastasis in PC was 19.4% at initial surgery and 25.0% including reoperations for recurrencies. High-risk Schulte staging and CDC73 abnormalities were identified as risk factors for cervical lymph node metastasis. Central LND should be considered during remedial surgeries performed after previous local resection of PC for patients with high risk factors. 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. MDPI 2022-08-19 /pmc/articles/PMC9406600/ /pubmed/36010997 http://dx.doi.org/10.3390/cancers14164004 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Hu, Ya Cui, Ming Chang, Xiaoyan Wang, Ou Chen, Tianqi Xiao, Jinheng Wang, Mengyi Hua, Surong Liao, Quan Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title | Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title_full | Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title_fullStr | Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title_full_unstemmed | Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title_short | Patterns and Predictors of Cervical Lymph Node Metastasis in Parathyroid Carcinoma |
title_sort | patterns and predictors of cervical lymph node metastasis in parathyroid carcinoma |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406600/ https://www.ncbi.nlm.nih.gov/pubmed/36010997 http://dx.doi.org/10.3390/cancers14164004 |
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