A retrospective study of the clinical and laboratory predictors and morphological characteristics of the parathyroid carcinoma

Abstract

Background: there are no specific markers of the parathyroid carcinoma (PC) therefore, the development of algorithms for identifying high-risk patients is an urgent task. Aims: to determine the clinical and laboratory predictors of PC and to identify the factors of a poor prognosis. Materials and methods: A multicenter retrospective study included 242 patients with primary hyperparathyroidism (PHPT) who were divided into groups: 162 with adenomas, 30 with аtypical adenomas (АА) and 50 patients with PC. Data collection and analysis was carried out from 2017 to 2020. The primary goal assessment of the possibility of PС using preoperative laboratory and instrumental data. The group of PC was divided into subgroups: the patients in recurrences (n=17) and remission (n=33). The level of the total calcium, albumin, alkaline phosphatase (ALP), ionized calcium (Ca ++) in the blood were determined on the automatic biochemical analyzer; the level of parathyroid hormone (PTH) by electrochemoluminescent analyzer. The size of the PG determined by the ellipse formula: V (cm3) = (A B C) 0.49. Statistical analysis was performed with Statistica 13 and SPSS software packages. For multiple comparisons, the Bonferroni correction was applied. Results: the group of patients with increased risk of PC include persons with increased level of PTH 443 pg/ml, Ca++ 1.5 mmol/l, total calcium 3.2 mmol/l, ALP 176 IU/L, V of tumors 2.6 cm3, largest size 22.5 mm (p 0,001). Heterogeneous structure is more typical to PC compared to the АА (p = 0,004 and р = 0,011), the same applies to indefinite contour (р = 0,001 и р = 0,011). Pathological mitosis is a prognostically unfavorable factor of recurrence of PC (р=0,007). Conclusions: the patients with PC and AA are characterized with more aggressive course of PHPT compared to the group of adenomas.