| Objective: Parathyroid carcinoma(PC)is a rare disease which is difficult to diagnose preoperatively and predict prognosis.The goal of this study was to analyse the preoperative predictive factors and prognostic factors in PC patients and to evaluate the possibility of diagnosing PC preoperatively and identify differences between Intrathyroidal parathyroid carcinoma(ITPC)and nonintrathyroidal parathyroid carcinoma(NIPC).Methods: 45 cases of parathyroid carcinoma(PC)in this study were collected from Jan 2000 to Mar 2016 conducted in Shanghai Ruijin Hospital.We reported special forms of PC in our hospital and review the case reports in literatures.Comparisons were made between 40 parathyroid carcinoma patients and 282 patients with benign parathyroid lesionsfrom Jan 2000 to Aug 2015.All patients underwent parathyroid surgery,and the results were certified by paraffin pathology.Prognostic factors were analysed in the 40 PC patients.Results: Patients with higher levels of intact parathyroid hormone(p<0.001,OR=1.001,CI: 1.000-1.002),calcium(P=0.008,OR=3.395,CI: 1.382-8.341)and a larger parathyroid volume(p=0.001,OR=2.023,CI: 1.333-3.071)were more likely to have PC.Local excision(p=0.008,OR=4.992,CI: 1.533-16.252),stage Ⅲ in the Schulte staging system(p=0.039,OR=9.600,CI: 1.12-82.322),high risk in the Schulte Risk Classification(p=0.012,OR=5.466,CI: 1.448-20.628)and first surgery by other medical teams(p=0.008,OR=4.992,CI: 1.496-15.037)were associated with PC recurrence.Calcium(p=0.01,OR=7.270,CI: 1.611-32.812),intact parathyroid hormone(p=0.037,OR=1.001,CI: 1.000-1.001),local excision(p=0.009,OR=6.875,CI: 1.633-28.936)and recurrence(p=0.014,OR=7.762,CI: 1.504-40.055)were associated with death.Among the 13 ITPC patients,the average onset age was 53.5±16.8 y,and the ratio of males to females was 1:1.6.Mean serum calcium level was 14.35±2.89 mg/d L,and the median PTH level was 652.0 pg/m L(range,205-2792 pg/m L)before surgery.Ultrasound and MIBI detection rates were 11/12(91.67%)and 7/9(77.78%),respectively.Only three cases were identified as intrathyroidal parathyroid lesions preoperatively,four patients(30.77%)underwent a total thyroidectomy,and nine patients(69.23%)underwent a hemithyroidectomy.Only one patient was diagnosed with local metastasis and died 32 months after the initial surgery.Significant differences between ITPC and NIPC were found in bilateral neck exploration(p<0.001),vascular invasion(p=0.041),thyroid invasion(p<0.001)and prognosis(p=0.034).Conclusions: A preoperative diagnostic system may provide a new method to distinguish PC from benign parathyroid lesions before surgery.For PC patients who did not undergo en-bloc resection at first operation,timely further surgery may offer a second chance of cure.Early diagnosis and surgery are pivotal to reduce mortality in PC patients.ITPC is a rare disease that cannot typically be diagnosed accurately before surgery.Serum calcium and PTH levels should be routinely examined in every patient with thyroid nodules.Preoperative location should be emphasized,and focused hemithyroidectomy is recommended instead of bilateral exploration.Compared with NIPC,ITPC may have a better prognosis. |
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