Local resection versus radical surgery for parathyroid carcinoma: A National Cancer Database analysis

Authors

Shravan Leonard-Murali, Henry Ford HealthFollow
Tommy Ivanics, Henry Ford HealthFollow
David S. Kwon, Henry Ford HealthFollow
Xiaoxia Han, Henry Ford HealthFollow
Christopher P. Steffes, Henry Ford HealthFollow
Rupen Shah, Henry Ford HealthFollow

Recommended Citation

Leonard-Murali S, Ivanics T, Kwon DS, Han X, Steffes CP, and Shah R. Local resection versus radical surgery for parathyroid carcinoma: A National Cancer Database analysis. Eur J Surg Oncol 2021; 47(11):2768-2773.

Document Type

Article

Publication Date

11-1-2021

Publication Title

European journal of surgical oncology

Abstract

INTRODUCTION: Parathyroid carcinoma (PC) is rare and often diagnosed incidentally after local resection (LR) for other indications. Although recommended treatment has traditionally been radical surgery (RS), more recent guidelines suggest that LR alone may be adequate. We sought to further investigate outcomes of RS versus LR for localized PC.

MATERIALS AND METHODS: PC patients from 2004 to 2015 with localized disease were identified from the National Cancer Database, then stratified by surgical therapy: LR or RS. Demographic and clinicopathologic data were compared. Cox proportional hazard models were constructed to estimate associations of variables with overall survival (OS). OS was estimated from time of diagnosis using Kaplan-Meier curves.

RESULTS: A total of 555 patients were included (LR = 522, RS = 33). The groups were comparable aside from LR patients having higher rates of unknown nodal status (66.9% versus 39.4%; p = 0.003). By multivariable analysis, RS did not have a significant association with OS (hazard ratio (HR) = 0.43, 95% confidence interval (95%CI) = 0.10, 1.83; p = 0.255), nor did positive nodal status (HR = 0.66, 95%CI = 0.09, 5.03; p = 0.692) and unknown nodal status (HR = 1.30, 95%CI = 0.78, 2.17; p = 0.311). There was no difference in OS between the LR and RS groups, with median survival not reached by either group at 10 years (median follow-up = 60.4 months; p = 0.20).

CONCLUSIONS: There was no difference in OS between LR and RS for localized PC. RS and nodal status may not impact survival as previously identified, and LR should remain a valid initial surgical approach. Future higher-powered studies are necessary to assess the effects of surgical approaches on morbidity and oncologic outcomes.

PubMed ID

34229923

Volume

47

Issue

11

First Page

2768

Last Page

2773