Kim EI, Eremkina AK, Elfimova AR, Mokrysheva NG. Search for clinical, genetic, morphological and immunohistochemical predictors of parathyroid cancer recurrence. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(10):958–967. DOI: 10.26442/00403660.2024.10.202872
Поиск клинических, генетических, морфологических и иммуногистохимических предикторов рецидива рака околощитовидных желез
Ким Е.И., Еремкина А.К., Елфимова А.Р., Мокрышева Н.Г. Поиск клинических, генетических, морфологических и иммуногистохимических предикторов рецидива рака околощитовидных желез. Терапевтический архив. 2024;96(10):958–967. DOI: 10.26442/00403660.2024.10.202872
Kim EI, Eremkina AK, Elfimova AR, Mokrysheva NG. Search for clinical, genetic, morphological and immunohistochemical predictors of parathyroid cancer recurrence. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(10):958–967. DOI: 10.26442/00403660.2024.10.202872
Обоснование. В настоящее время не существует единых подходов к послеоперационной стратификации рисков у пациентов с раком околощитовидных желез (РОЩЖ). Определение неблагоприятных прогностических факторов течения заболевания необходимо для выбора оптимальной лечебной стратегии, в том числе для определения целесообразности применения адъювантных методов и дальнейшего наблюдения за больным. Цель. Определить предикторы рецидива РОЩЖ. Материалы и методы. Проведено ретроспективное наблюдательное исследование с включением 85 пациентов с верифицированным РОЩЖ, которые разделены на группы ремиссии (n=61) и рецидива (n=19) после первичного хирургического лечения в 2004–2023 гг. Анализируемые показатели включали демографические, лабораторно-инструментальные данные больных РОЩЖ, наличие мутации в гене CDC73, морфологические и иммуногистохимические характеристики первичной опухоли. Результаты. Выявлена статистически значимая ассоциация рецидива с уровнем дооперационного кальция общего (p<0,001), стадией pT4 (p<0,001) по TNM-классификации (Tumor, Nodus, Metastasis) злокачественных новообразований согласно Американскому объединенному комитету по борьбе с раком 2017 г. Установлена тенденция к различиям у пациентов с рецидивом и без по уровню скорректированного по альбумину кальция (p=0,002), наличию нефролитиаза/нефрокальциноза (p=0,021), уровню паратиреоидного гормона через 6 мес после первичной операции (p<0,05), стадии pT3 по TNM-классификации (p=0,007), ядерной экспрессии парафибромина в ткани опухоли (p<0,05). Данных о наличии связи рецидива заболевания с полом, возрастом, объемом хирургического лечения, наличием герминальной мутации в гене CDC73, экспрессией парафибромина в ткани опухоли и индексом пролиферативной активности Ki-67 не получено. Заключение. Определены клинико-лабораторные и морфологические факторы неблагоприятного прогноза, позволяющие выделить группу риска рецидива, что может способствовать активному динамическому наблюдению и своевременному назначению лечения.
Background. Currently, there is no consensus on postoperative risk stratification for parathyroid cancer (PC). The risk factors of disease progression are crucial for choosing the optimal treatment strategy, including adjuvant methods and patient,s follow-up. Aim. Identifying predictors of PC recurrence Materials and methods. We performed a retrospective observational study of 85 patients with verified PC divided into remission (n=61) and recurrence (n=19) groups after primary surgical treatment for the period 2004–2023. The analyzed parameters included demographic, laboratory and instrumental data of patients with PC, the presence of a mutation in the CDC73 gene, morphological and immunohistochemical characteristics of the primary tumor. Results. After adjustments for multiple comparisons, a statistically significant association of recurrence was found for preoperative calcium level (p<0.001), pT4 stage (p<0.001) according to TNM-classification (Tumor, Nodus, Metastasis) American Joint Committee on Cancer 2017. There was a statistical trend for calcium correction for hypoalbuminemia (p=0.002), presence of nephrolithiasis/nephrocalcinosis (p=0.021), parathyroid hormone level 6 months after primary surgery (p<0.05), pT3 stage TNM (p=0.007), nuclear expression of parafibromin in tumor tissue (p<0.05). We did not reveal any associations between disease recurrence and sex, age, volume of surgical treatment, germline mutation in the CDC73, parafibromin expression and Ki-67 in tumor tissue. Conclusion. Our study revealed several factors of poor prognosis, allowing to identify a risk group for recurrence, which can contribute to active dynamic monitoring and timely treatment.
1. Talat N, Schulte KM. Clinical presentation, staging and long-term evolution of parathyroid cancer. Ann Surg Oncol. 2010;17(8):2156-74. DOI:10.1245/s10434-010-1003-6
2. Xue S, Chen H, Lv C, et al. Preoperative diagnosis and prognosis in 40 Parathyroid Carcinoma Patients. Clin Endocrinol (Oxf). 2016;85(1):29-36. DOI:10.1111/cen.13055
3. Rodrigo JP, Hernandez-Prera JC, Randolph GW, et al. Parathyroid cancer: An update. Cancer Treat Rev. 2020;86:102012. DOI:10.1016/j.ctrv.2020.102012
4. Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: a 22-year experience. Head Neck. 2004;26(8):716-26. DOI:10.1002/hed.20049
5. Iacobone M, Lumachi F, Favia G. Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol. 2004;88(4):223-8. DOI:10.1002/jso.20152
6. Van der Zwan JM, Mallone S, van Dijk B, et al. Carcinoma of endocrine organs: results of the RARECARE project. Eur J Cancer. 2012;48(13):1923-31. DOI:10.1016/j.ejca.2012.01.029
7. Sadler C, Gow KW, Beierle EA, et al. Parathyroid carcinoma in more than 1,000 patients: A population-level analysis. Surgery. 2014;156(6):1622-9. DOI:10.1016/j.surg.2014.08.069
8. Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer. 2007;109(9):1736-41. DOI:10.1002/cncr.22599
9. Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg. 1992;16(4):724-31. DOI:10.1007/BF02067369
10. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1999;86(3):538-44. DOI:10.1002/(sici)1097-0142(19990801)86:33.0.co;2-k
11. Silva-Figueroa AM, Hess KR, Williams MD, et al. Prognostic Scoring System to Risk Stratify Parathyroid Carcinoma. J Am Coll Surg. 2017;S1072-7515(17)30179-5.
DOI: 10.1016/j.jamcollsurg.2017.01.060
12. Witteveen JE, Hamdy NA, Dekkers OM, et al. Downregulation of CASR expression and global loss of parafibromin staining are strong negative determinants of prognosis in parathyroid carcinoma. Mod Pathol. 2011;24(5):688-97. DOI:10.1038/modpathol.2010.236
13. Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145-58. DOI:10.1016/S0140-6736(09)60507-9
14. Мокрышева Н.Г., Еремкина А.К., Мирная С.С., и др. Клинические рекомендации по первичному гиперпаратиреозу, краткая версия. Проблемы Эндокринологии. 2021;67(4):94-124 [Mokrysheva NG, Eremkina AK, Mirnaya SS, et al. The clinical practice guidelines for primary hyperparathyroidism, short version. Problems of Endocrinology. 2021;67(4):94-124 (in Russian)]. DOI:10.14341/probl12801
15. Kleinpeter KP, Lovato JF, Clark PB, et al. Is parathyroid carcinoma indeed a lethal disease? Ann Surg Oncol. 2005;12(3):260-6. DOI:10.1245/ASO.2005.03.036
16. Hsu KT, Sippel RS, Chen H, Schneider DF. Is central lymph node dissection necessary for parathyroid carcinoma? Surgery. 2014;156(6):1336-41; discussion 1341. DOI:10.1016/j.surg.2014.08.005
17. Schaapveld M, Jorna FH, Aben KK, et al. Incidence and prognosis of parathyroid gland carcinoma: a population-based study in The Netherlands estimating the preoperative diagnosis. Am J Surg. 2011;202(5):590-7. DOI:10.1016/j.amjsurg.2010.09.025
18. Roser P, Leca BM, Coelho C, et al. Diagnosis and management of parathyroid carcinoma: a state-of-the-art review. Endocr Relat Cancer. 2023;30(4). DOI:10.1530/ERC-22-0287
19. Liu Y, Li J, Liu H, et al. Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review. Front Endocrinol (Lausanne). 2021;12:766234. DOI:10.3389/fendo.2021.766234
20. Крупинова Ю.А., Воронкова И.А., Айнетдинова А.Р., и др. Многоцентровое ретроспективное исследование клинико-лабораторных предикторов и морфологических характеристик рака околощитовидной железы. Вестник РАМН. 2021;76(1):111-24 [Krupinova JA, Voronkova IA, Ajnetdinova AR, et al. A retrospective study of the clinical and laboratory predictors and morphological characteristics of the parathyroid carcinoma. Annals of the Russian Academy of Medical Sciences. 2021;76(1):111-24 (in Russian)].
DOI: 10.15690/vramn1458
21. Lo WM, Good ML, Nilubol N, et al. Tumor Size and Presence of Metastatic Disease at Diagnosis are Associated with Disease-Specific Survival in Parathyroid Carcinoma. Ann Surg Oncol. 2018;25(9):2535-40. DOI:10.1245/s10434-018-6559-6
22. Asare EA, Sturgeon C, Winchester DJ, et al. Parathyroid Carcinoma: An Update on Treatment Outcomes and Prognostic Factors from the National Cancer Data Base (NCDB). Ann Surg Oncol. 2015;22(12):3990-5. DOI:10.1245/s10434-015-4672-3
23. Lenschow C, Schrägle S, Kircher S, et al. Clinical Presentation, Treatment and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study. SSRN Electronic Journal. 2020. DOI:10.2139/ssrn.3541131
24. Iihara M, Okamoto T, Suzuki R, et al. Functional parathyroid carcinoma: Long-term treatment outcome and risk factor analysis. Surgery. 2007;142(6):936-43. DOI:10.1016/j.surg.2007.09.014
25. Erovic BM, Goldstein DP, Kim D, et al. Parathyroid cancer: outcome analysis of 16 patients treated at the Princess Margaret Hospital. Head Neck. 2013;35(1):35-9. DOI:10.1002/hed.22908
26. Lenschow C, Schrägle S, Kircher S, et al. Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study. Ann Surg. 2022;275(2):e479-87. DOI:10.1097/SLA.0000000000004144
27. Li Y, Simonds WF. Endocrine neoplasms in familial syndromes of hyperparathyroidism. Endocr Relat Cancer. 2016;23(6):R229-47. DOI:10.1530/ERC-16-0059
28. Leonard-Murali S, Ivanics T, Kwon DS, et al. Local resection versus radical surgery for parathyroid carcinoma: A National Cancer Database analysis. Eur J Surg Oncol. 2021;47(11):2768-73. DOI:10.1016/j.ejso.2021.06.026
29. Cetani F, Banti C, Pardi E, et al. CDC73 mutational status and loss of parafibromin in the outcome of parathyroid cancer. Endocr Connect. 2013;2(4):186-95. DOI:10.1530/EC-13-0046
30. Hu Y, Bi Y, Cui M, et al. The Influence of Surgical Extent and Parafibromin Staining on the Outcome of Parathyroid Carcinoma: 20-Year Experience from a Single Institute. Endocr Pract. 2019;25(7):634-41. DOI:10.4158/EP-2018-0538
31. Magnabosco FF, Brescia MDG, Nascimento Júnior CP, et al. Time to Recurrence as a Prognostic Factor in Parathyroid Carcinoma. J Endocr Soc. 2023;7(7):bvad067. DOI:10.1210/jendso/bvad067
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1. Talat N, Schulte KM. Clinical presentation, staging and long-term evolution of parathyroid cancer. Ann Surg Oncol. 2010;17(8):2156-74. DOI:10.1245/s10434-010-1003-6
2. Xue S, Chen H, Lv C, et al. Preoperative diagnosis and prognosis in 40 Parathyroid Carcinoma Patients. Clin Endocrinol (Oxf). 2016;85(1):29-36. DOI:10.1111/cen.13055
3. Rodrigo JP, Hernandez-Prera JC, Randolph GW, et al. Parathyroid cancer: An update. Cancer Treat Rev. 2020;86:102012. DOI:10.1016/j.ctrv.2020.102012
4. Busaidy NL, Jimenez C, Habra MA, et al. Parathyroid carcinoma: a 22-year experience. Head Neck. 2004;26(8):716-26. DOI:10.1002/hed.20049
5. Iacobone M, Lumachi F, Favia G. Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol. 2004;88(4):223-8. DOI:10.1002/jso.20152
6. Van der Zwan JM, Mallone S, van Dijk B, et al. Carcinoma of endocrine organs: results of the RARECARE project. Eur J Cancer. 2012;48(13):1923-31. DOI:10.1016/j.ejca.2012.01.029
7. Sadler C, Gow KW, Beierle EA, et al. Parathyroid carcinoma in more than 1,000 patients: A population-level analysis. Surgery. 2014;156(6):1622-9. DOI:10.1016/j.surg.2014.08.069
8. Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer. 2007;109(9):1736-41. DOI:10.1002/cncr.22599
9. Sandelin K, Auer G, Bondeson L, et al. Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg. 1992;16(4):724-31. DOI:10.1007/BF02067369
10. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1999;86(3):538-44. DOI:10.1002/(sici)1097-0142(19990801)86:33.0.co;2-k
11. Silva-Figueroa AM, Hess KR, Williams MD, et al. Prognostic Scoring System to Risk Stratify Parathyroid Carcinoma. J Am Coll Surg. 2017;S1072-7515(17)30179-5.
DOI: 10.1016/j.jamcollsurg.2017.01.060
12. Witteveen JE, Hamdy NA, Dekkers OM, et al. Downregulation of CASR expression and global loss of parafibromin staining are strong negative determinants of prognosis in parathyroid carcinoma. Mod Pathol. 2011;24(5):688-97. DOI:10.1038/modpathol.2010.236
13. Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145-58. DOI:10.1016/S0140-6736(09)60507-9
14. Mokrysheva NG, Eremkina AK, Mirnaya SS, et al. The clinical practice guidelines for primary hyperparathyroidism, short version. Problems of Endocrinology. 2021;67(4):94-124 (in Russian). DOI:10.14341/probl12801
15. Kleinpeter KP, Lovato JF, Clark PB, et al. Is parathyroid carcinoma indeed a lethal disease? Ann Surg Oncol. 2005;12(3):260-6. DOI:10.1245/ASO.2005.03.036
16. Hsu KT, Sippel RS, Chen H, Schneider DF. Is central lymph node dissection necessary for parathyroid carcinoma? Surgery. 2014;156(6):1336-41; discussion 1341. DOI:10.1016/j.surg.2014.08.005
17. Schaapveld M, Jorna FH, Aben KK, et al. Incidence and prognosis of parathyroid gland carcinoma: a population-based study in The Netherlands estimating the preoperative diagnosis. Am J Surg. 2011;202(5):590-7. DOI:10.1016/j.amjsurg.2010.09.025
18. Roser P, Leca BM, Coelho C, et al. Diagnosis and management of parathyroid carcinoma: a state-of-the-art review. Endocr Relat Cancer. 2023;30(4). DOI:10.1530/ERC-22-0287
19. Liu Y, Li J, Liu H, et al. Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review. Front Endocrinol (Lausanne). 2021;12:766234. DOI:10.3389/fendo.2021.766234
20. Krupinova JA, Voronkova IA, Ajnetdinova AR, et al. A retrospective study of the clinical and laboratory predictors and morphological characteristics of the parathyroid carcinoma. Annals of the Russian Academy of Medical Sciences. 2021;76(1):111-24 (in Russian). DOI: 10.15690/vramn1458
21. Lo WM, Good ML, Nilubol N, et al. Tumor Size and Presence of Metastatic Disease at Diagnosis are Associated with Disease-Specific Survival in Parathyroid Carcinoma. Ann Surg Oncol. 2018;25(9):2535-40. DOI:10.1245/s10434-018-6559-6
22. Asare EA, Sturgeon C, Winchester DJ, et al. Parathyroid Carcinoma: An Update on Treatment Outcomes and Prognostic Factors from the National Cancer Data Base (NCDB). Ann Surg Oncol. 2015;22(12):3990-5. DOI:10.1245/s10434-015-4672-3
23. Lenschow C, Schrägle S, Kircher S, et al. Clinical Presentation, Treatment and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study. SSRN Electronic Journal. 2020. DOI:10.2139/ssrn.3541131
24. Iihara M, Okamoto T, Suzuki R, et al. Functional parathyroid carcinoma: Long-term treatment outcome and risk factor analysis. Surgery. 2007;142(6):936-43. DOI:10.1016/j.surg.2007.09.014
25. Erovic BM, Goldstein DP, Kim D, et al. Parathyroid cancer: outcome analysis of 16 patients treated at the Princess Margaret Hospital. Head Neck. 2013;35(1):35-9. DOI:10.1002/hed.22908
26. Lenschow C, Schrägle S, Kircher S, et al. Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study. Ann Surg. 2022;275(2):e479-87. DOI:10.1097/SLA.0000000000004144
27. Li Y, Simonds WF. Endocrine neoplasms in familial syndromes of hyperparathyroidism. Endocr Relat Cancer. 2016;23(6):R229-47. DOI:10.1530/ERC-16-0059
28. Leonard-Murali S, Ivanics T, Kwon DS, et al. Local resection versus radical surgery for parathyroid carcinoma: A National Cancer Database analysis. Eur J Surg Oncol. 2021;47(11):2768-73. DOI:10.1016/j.ejso.2021.06.026
29. Cetani F, Banti C, Pardi E, et al. CDC73 mutational status and loss of parafibromin in the outcome of parathyroid cancer. Endocr Connect. 2013;2(4):186-95. DOI:10.1530/EC-13-0046
30. Hu Y, Bi Y, Cui M, et al. The Influence of Surgical Extent and Parafibromin Staining on the Outcome of Parathyroid Carcinoma: 20-Year Experience from a Single Institute. Endocr Pract. 2019;25(7):634-41. DOI:10.4158/EP-2018-0538
31. Magnabosco FF, Brescia MDG, Nascimento Júnior CP, et al. Time to Recurrence as a Prognostic Factor in Parathyroid Carcinoma. J Endocr Soc. 2023;7(7):bvad067. DOI:10.1210/jendso/bvad067