AUTHOR=Qian Bei , Qian Ying , Hu Longqing , Zhang Shoupeng , Mei Li , Qu Xincai 

TITLE=Prognostic Analysis for Patients With Parathyroid Carcinoma: A Population-Based Study

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 16 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.784599

DOI=10.3389/fnins.2022.784599

ISSN=1662-453X

ABSTRACT=Background: Parathyroid carcinoma (PC) is a rare, but often lethal malignancy, for which staging system, prognostic indicators and treatment guidelines is still not established. We aimed to explore the prognostic parameters and construct a nomogram for cancer-specific survival (CSS) of PC.

Methods: A retrospective analysis of 604 PC patients in the SEER database from 2001 through 2018 was performed. All the cases were randomly assigned to the training cohort (n=424) or the validation cohort (n =180) at a ratio of 7:3. Kaplan-Meier method and cox regression model was applied to estimate the CSS and risk factors, and a nomogram was constructed. The predictive accuracy and discriminative ability of the nomogram in CSS were assessed by concordance index (C-index), the area under the curve (AUC) of operating characteristics (ROC) and calibration curve.

Results: Age at diagnosis > 70 years (hazard ratio (HR): 3.55, 95% confidence interval (CI):1.07-11.78, P = 0.039), tumor size > 35mm (HR:4.22; 95%CI:1.67-10.68, P = 0.002) were associated with worse CSS. Compared with distant metastasis, localized (HR:0.17; 95%CI:0.06-0.47, P = 0.001) and regional lesions (HR:0.22; 95%CI:0.07-0.66, P = 0.007) showed an improved CSS rate. Parathyroidectomy was the recommended treatment (P = 0.02). The C-index of the nomogram was 0.826, and AUC for 5-, 10-, and 15-year-CSS was 83.7%, 79.7% and 80.7% respectively. The calibration curve presented good agreement between prediction by nomogram and actual observation.

Conclusion: Age at diagnosis >70 years, tumor size >35mm, and distant metastasis were independent risk factors for PC-specific mortality. Parathyroidectomy were currently the most recommended treatments for PC. This nomogram provided individualized assessment and reliable prognostic prediction for patients with PC.