中国实用外科杂志

中国实用外科杂志

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甲状旁腺癌59例临床预后相关因素及生存分析

陶    梅1a，罗叔岩2，崔    黎1b，卢秀波1a   

  1. 1郑州大学第一附属医院  a.甲状腺外科  b.病理科，河南郑州 450052；2中国医科大学附属第一医院神经外科，辽宁沈阳110001
  • 出版日期:2021-05-01 发布日期:2021-05-17

  • Online:2021-05-01 Published:2021-05-17

摘要： 目的    分析甲状旁腺癌（PC）的临床病理特点和影响无进展生存期（PFS）的相关因素。  方法    回顾性分析2012—2020年郑州大学第一附属医院59例初次手术PC病人的临床病理资料，采用Cox比例风险回归模型分析影响PFS的临床因素，并将相关危险因素进一步采用Log-rank检验进行生存曲线比较。结果    59例病人均获得随访。中位随访时间32（3~104）个月。5年总生存率89.0%，无进展生存率为79.9%。多因素分析显示肿瘤大小（P=0.046）及术前甲状旁腺素（PTH）水平（P=0.013）是影响PC病人PFS的主要危险因素；生存曲线比较结果显示，肿瘤直径低风险组（直径8.5～＜25.0 mm，23例）PFS大于高风险组（直径25.0～66.5 mm，36例）（χ2size=6.562，P=0.010），术前PTH低风险组（PTH 58～＜1654 ng/L，43例）PFS大于高风险组（PTH 1654～2689 ng/L，16例）（χ2PTH=9.754，P=0.002）。肿瘤直径在25.0～66.5 mm 且术前PTH在 1654～2689 ng/L的PC病人定义为超高风险组（12例），肿瘤直径8.5～＜25.0 mm 或术前PTH 58～＜1654 ng/L的PC病人为一般组（47例），超高风险组疾病进展的HR是19.47，两组PFS生存曲线比较差异有统计学意义（HR=19.370，95%CI 2.535-148.100，P＜0.001）。结论    肿瘤大小和术前PTH水平是PC术后进展的相关危险因素，对肿瘤直径较大和PTH水平较高的PC病人需进行密切随访和监测。

关键词: 甲状旁腺癌, 高钙血症, 无进展生存期, 递归分区分析, 预后

Abstract: Parathyroid cancer：A prognostic factors and survival analysis of 59 cases        TAO Mei*, LUO Shu-yan, CUI Li, et al. *Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Corresponding author:LU Xiu-bo, E-mail:doctorluxiubo@126.com
Abstract    Objective    To analyze the clinicopathological features of parathyroid cancer（PC）and probe into the prognostic factors affecting progression-free survival (PFS). Methods    The clinicopathological data of 59 PC patients operated on parathyroidectomy for the first time in the First Affiliated Hospital of Zhengzhou University from 2012 to 2020 were analyzed retrospectively. The clinicopathological data were collected to explore the relative factors affecting the PFS according to Cox regression analysis, and the risk factors were divided into two groups for comparison by Log-rank test. Results    A total of 59 patients were assessed at a median follow-up of 32 (3 to 104) months. The 5-year overall survival rate was 89.0%, and the Kaplan-Meier PFS rate was 79.9% at 5 years. Multivariate analysis demonstrated that tumor diameter (P=0.046) and preoperative parathyroid hormone (PTH) level (P=0.013) were the leading risk factors affecting PFS in PC patients. There were 36 patients with tumour diameter from 25.0 to 66.5mm and 16 patients with preoperative PTH level form 1654 to 2689 ng/L respectively defined as high-risk groups were negatively correlated with PFS rate after the comparison of survival curves (χ2size=6.562，P=0.010，χ2PTH=9.754，P=0.002). Twelve patients with tumour diameter from 25.0 to 66.5 mm and preoperative PTH from 1654 to 2689 ng/L were defined as ultrahigh-risk group, and the rest of patients were named general group. The HR for disease progressing in ultrahigh-risk group was 19.47, and the difference between the groups was  significant statisticly (HR=19.370,95%CI 2.535-148.100, P＜0.001). Conclusion    Tumour size and preoperative PTH levels are relative risk factors of PC postoperative progression. PC patients with larger tumour sizes or higher PTH require close follow-up and monitoring.

Key words: parathyroid cancer, hypercalcemia, progression-free survival, recursive partioning analysis；prognosis