甲状旁腺癌的临床特征和术前预测因子分析

Analysis of preoperative predictive factors and clinical characteristics in patients with parathyroid carcinoma

目的探讨甲状旁腺癌（PC）的临床特点和术前预测因子。方法回顾性分析2010年1月至2016年12月北京世纪坛医院收治的经手术病理和生化证实的150例原发性甲状旁腺功能亢进症（PHPT）患者的临床资料，其中甲状旁腺增生患者28例，PC 14例，甲状旁腺腺瘤（PA）108例，比较PC组和PA组患者的临床特点，并分析预测PC的有效因子。结果PC组患者的年龄为（47.9±13.9）岁，明显小于PA组患者[（57.2±14.6）岁，P＝0.026]。PC组患者的肿瘤直径为（3.6±1.8）cm，明显大于PA组患者[（2.2±1.4）cm，P＝0.005]。PC组患者的血清校正钙、甲状旁腺素（PTH）、碱性磷酸酶（AKP）水平分别为（3.4±0.6）mmol/L、1 157.1 pg/ml和168 IU/L，明显高于PA组患者[分别为（2.9±0.3）mmol/L、201.6 pg/ml和97 IU/L，均P〈0.05]。PC与患者的年龄（r＝－0.241，P＝0.007）、血清校正钙（r＝0.324，P〈0.001）、PTH（r＝0.301，P＝0.001）、AKP（r＝0.217，P＝0.019）和肿瘤直径（r＝0.238，P＝0.011）明显相关。受试者工作特征曲线分析显示，血清校正钙的最佳截点值为3.15 mmol/L，PTH的最佳截点值为1 011 pg/ml，肿瘤直径的最佳截点值为3.35 cm，有助于PC的术前诊断。结论与PA患者比较，PC患者的年龄相对较轻，血清校正钙、PTH和肿瘤直径对PC的术前诊断有价值。

ObjectiveTo evaluate the clinical characteristics and preoperative predictive factors in patients with parathyroid carcinoma.MethodsFrom January 2010 to December 2016, 150 patients with pathologically and biochemically confirmed primary hyperparathyroidism were enrolled in this study. The clinical data were reviewed to define 28 cases of parathyroid hyperplasia, 14 cases of parathyroid carcinoma （PC）, and 108 cases of parathyroid adenoma （PA）. The clinical characteristics between PC and PA group were compared and analyzed to explore predictive factors for PC.ResultsPatients in PC group were significantly younger than those in PA group （47.9±13.9 vs 57.2±14.6 years, P=0.026）. The diameter of tumor in PC group was larger than that in PA group （3.6±1.8 vs 2.2±1.4 cm, P=0.005）. The levels of albumin-corrected serum calcium, parathyroid hormone （PTH）, and alkaline phosphatase （AKP） were all higher in PC group than those in PA group （3.4±0.6 vs 2.9±0.3 mmol/l; 1 157.1 vs 201.6 pg/ml; 168 vs 97 IU/L; all P〈0.05）. PC correlated with age（r=-0.241, P=0.007）, albumin-corrected serum calcium （r=0.324, P〈0.001）, PTH levels （r=0.301, P=0.001）, serum AKP （r=0.217, P=0.019） and tumor size（r=0.238, P=0.011）. Receiver operator characteristic curve analysis showed that the optimum cut-off values as follows： albumin-corrected serum calcium 3.15 mmol/L, serum PTH concentration 1 011 pg/ml and tumor diameter 3.35 cm. These indicators can be helpful in the preoperative diagnosis of PC.ConclusionsPatients with PC were younger than the patients with PA. Albumin-corrected serum calcium, serum PTH concentration, and tumor diameter can be helpful in preoperative diagnosis of PC.