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Classification of Parathyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Parathyroid cancer is rare and often has a poor outcome. There is no classification system that permits prediction of outcome in patients with parathyroid cancer. This study was designed to validate two prognostic classification systems developed by Talat and Schulte in 2010 (“Clinical Presentation, Staging and Long-term Evolution of Parathyroid Cancer,” Ann Surg Oncol 2010;17:2156–74) derived from a retrospective literature review of 330 patients.

Methods

This study contains 82 formerly unreported patients with parathyroid cancer. Death due to disease was the primary end point, and recurrence and disease-free survival were the secondary end points. Data acquisition used a questionnaire of predefined criteria. Low risk was defined by capsular and soft tissue invasion alone; high risk was defined by vascular or organ invasion, and/or lymph node or distant metastasis. A differentiated classification system further classified high-risk cancer into vascular invasion alone (class II), lymph node metastasis or organ invasion (class III), and distant metastasis (class IV). Statistical analyses included risk analysis, Kaplan-Meier analysis, and receiver–operating characteristic (ROC) analysis.

Results

Follow-up ranged 2–347 months (mean 76 months). Mortality was exclusive to the high- risk group, which also predicted a significant risk of recurrence (risk ratio 9.6; 95% confidence interval 2.4–38.4; P < 0.0001), with significantly lower 5-year disease-free survival (χ2 = 8.7; P < 0.005 for n = 45). The differentiated classification also provided a good prognostic model with an area under the ROC curve of 0.83 in ROC analysis, with significant impairment of survival between classes (98.6%, 79.2%, 71.4%, 40.0%, P < 0.05 between each class).

Conclusions

This study confirms the validity of both classification systems for disease outcome in patients with parathyroid cancer.

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Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, King’s College Hospital, King’s Health Partners, London, UK

    Klaus-Martin Schulte MD, FRCS & Nadia Talat BSc Hons

  2. Department of Anatomical Pathology, Royal North Shore Hospital, St. Leonards, NSW, Australia

    Anthony J. Gill FRCPA

  3. Department of Endocrine Surgery, Jagiellonian University College of Medicine, Krakow, Poland

    Marcin Barczynski MD

  4. Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, Marburg, Germany

    Elias Karakas MD

  5. Department of Surgery, Kuma Hospital, Kuma, Japan

    Akira Miyauchi MD

  6. Department of General and Visceral Surgery, Heinrich-Heine University, Düsseldorf, Germany

    W. T. Knoefel MD

  7. Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Celestino Pio Lombardi MD

  8. Department of Pathology, King’s College Hospital, King’s Health Partners, London, UK

    Salvador Diaz-Cano FRCPath

  9. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Clive S. Grant MD

Authors
  1. Klaus-Martin Schulte MD, FRCS
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  2. Anthony J. Gill FRCPA
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  3. Marcin Barczynski MD
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  4. Elias Karakas MD
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  5. Akira Miyauchi MD
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  6. W. T. Knoefel MD
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  7. Celestino Pio Lombardi MD
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  8. Nadia Talat BSc Hons
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  9. Salvador Diaz-Cano FRCPath
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  10. Clive S. Grant MD
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Corresponding author

Correspondence to Klaus-Martin Schulte MD, FRCS.

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Schulte, KM., Gill, A.J., Barczynski, M. et al. Classification of Parathyroid Cancer. Ann Surg Oncol 19, 2620–2628 (2012). https://doi.org/10.1245/s10434-012-2306-6

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  • DOI: https://doi.org/10.1245/s10434-012-2306-6

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