Integrating histology and biomarkers to predict clinical outcomes in parathyroid tumors: a multicenter study
Authors' conclusion
The composite histology-biomarker risk score was linearly associated with biochemical severity and postoperative outcomes, offering a practical tool to refine risk stratification beyond histological classification.
Study context
- Population
- Patients with PHPT caused by typical adenoma (TA), atypical parathyroid tumor (APT) or nonmetastatic parathyroid carcinoma (PC), diagnosed 2000–2021 in three tertiary hospitals; 64.7% women, mean age 58.3 ± 13.6 yearsanalysed
- Participants
- 139 patients
- Exposure
- Composite histology-biomarker risk score vs postoperative outcomes
- TAn = 90
- APTn = 20
- PCn = 29
- Outcome
- Postoperative outcomes by composite risk score
Methodological detailsmulticenter, three tertiary hospitals, Score: one point each for atypical/malignant histology, loss of parafibromin, Ki-67 ≥ 3%, positive galectin-3 or PGP9.5 expression
- Multicenter
- Three tertiary hospitals
- Score: one point each for atypical/malignant histology, loss of parafibromin, Ki-67 ≥ 3%, positive galectin-3 or PGP9.5 expression
Main finding
As reported in the abstract
Postoperative hypocalcemia, score 0 to scores ≥ 4
0% to 53%
Persistent hyperparathyroidism, from lowest to highest score (P < .01)
6% to 45%
Postoperative hypocalcemia per one-point score increase, OR (adjusted for age, sex, CKD, surgical extent)
2.00
Persistent hyperparathyroidism per one-point score increase, OR (adjusted for age, sex, CKD, surgical extent)
1.87
Observational data: associations, not effects.
Further findings
Preoperative parathyroid hormone (PTH) and calcium levels by risk score
- Increased progressively with the risk score (P < .001)
Model discrimination
- AUC (ROC)
- 0.78-0.81
- Calibration stable
Original publication
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