Christina Lenschow1, Sina Schrägle1, Stefan Kircher2, Kerstin Lorenz3, Andreas Machens3, Henning Dralle4, Philipp Riss5, Christian Scheuba5, Andreas Pfestroff6, Christine Spitzweg7, Andreas Zielke8, Anna Nießen9, Cornelia Dotzenrath10, Burkhard Riemann11, Marcus Quinkler12, Christian Vorländer13, Alexandra Zahn14, Friedhelm Raue15, Costanza Chiapponi16, Karl Alexander Iwen17, Thomas Steinmüller18, Matthias Kroiss19,20, Nicolas Schlegel1. 1. Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany. 2. Institute of Pathology, University of Würzburg, Würzburg, Germany. 3. University Hospital Halle, Department of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Halle, Germany. 4. Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany. 5. University Hospital of Vienna, Department of Surgery, Vienna, Austria. 6. University Hospital Marburg, Department of Nuclear Medicine, University Hospital Marburg, Germany. 7. University Hospital Munich, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany. 8. Diakonie Hospital Stuttgart, Depart for endocrine Surgery, Stuttgart, Germany. 9. Heidelberg University Hospital, Department of General, Visceral and Transplantation Surgery, Heidelberg, Germany. 10. Helios University Hospital Wuppertal, Department of Endocrine Surgery, Wuppertal, Germany. 11. University Hospital of Muenster, Department of Nuclear Medicine, Muenster, Germany. 12. Endocrine Practice Berlin-Charlottenburg, Berlin, Germany. 13. Buergerhospital Frankfurt am Main, Department for Endocrine Surgery, Frankfurt, Germany. 14. Schön-Klinik Hamburg, Department of Endocrine Surgery, Hamburg, Germany. 15. Endocrine and Nuclear Practice Heidelberg, Heidelberg, Germany. 16. University Hospital Cologne, Department of General, - Visceral, Tumor and Transplantation Surgery, Colognen, Germany. 17. University Hospital Schleswig-Holstein Campus Lübeck, University MVZ Lübeck, Lübeck, Germany. 18. DRK-Hospital Berlin, Department of General, Visceral and Minimal invasive Surgery, Berlin, Germany. 19. Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany. 20. Comprehensive Cancer Center Wuerzburg, University Hospital Würzburg, Germany.
Abstract
OBJECTIVE: In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival. SUMMARY BACKGROUND DATA: PC is an orphan malignancy for which diagnostic workup and treatment is not established. METHODS: Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review. RESULTS: Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P = 0.04). In multivariate analysis low T status [odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.02-6.88, P = 0.045], N0 stage at initial diagnosis (OR = 6.32, 95% CI 1.33-30.01, P = 0.02), Ki-67 <10% (OR = 14.07, 95% CI 2.09-94.9, P = 0.007), and postoperative biochemical remission (OR = 0.023, 95% CI 0.001-0.52, P = 0.018) were beneficial prognostic parameters for recurrence-free survival. CONCLUSION: Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed.
OBJECTIVE: In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival. SUMMARY BACKGROUND DATA: PC is an orphan malignancy for which diagnostic workup and treatment is not established. METHODS: Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review. RESULTS: Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P = 0.04). In multivariate analysis low T status [odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.02-6.88, P = 0.045], N0 stage at initial diagnosis (OR = 6.32, 95% CI 1.33-30.01, P = 0.02), Ki-67 <10% (OR = 14.07, 95% CI 2.09-94.9, P = 0.007), and postoperative biochemical remission (OR = 0.023, 95% CI 0.001-0.52, P = 0.018) were beneficial prognostic parameters for recurrence-free survival. CONCLUSION: Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed.
Authors: Christina Lenschow; Carmina Teresa Fuss; Stefan Kircher; Andreas Buck; Ralph Kickuth; Joachim Reibetanz; Armin Wiegering; Albrecht Stenzinger; Daniel Hübschmann; Christoph Thomas Germer; Martin Fassnacht; Stefan Fröhling; Nicolas Schlegel; Matthias Kroiss Journal: Front Endocrinol (Lausanne) Date: 2021-03-23 Impact factor: 5.555
Authors: Anne Hendricks; Christina Lenschow; Matthias Kroiss; Andreas Buck; Ralph Kickuth; Christoph-Thomas Germer; Nicolas Schlegel Journal: Langenbecks Arch Surg Date: 2021-05-16 Impact factor: 3.445