title: Parathyroid carcinoma: a 43-year outcome and survival analysis.
abstract: BACKGROUND
  Parathyroid carcinoma is a rare but ominous cause of primary hyperparathyroidism. OBJECTIVES AND MAIN OUTCOME MEASURES: The objective of the study was to review the outcomes of parathyroid cancer patients and to evaluate the factors associated with mortality.
  
  
  METHODS
  This was a retrospective review performed on 37 patients with parathyroid cancer treated at a single university tertiary care center between 1966 and 2009.
  
  
  RESULTS
  The average age at cancer diagnosis was 53 yr (range 23-75 yr), and 23 patients (62%) were men. Eighteen patients (49%) recurred after their initial cancer operation. The average number of neck dissections done for cancer was three (range 1-11). After initial diagnosis, 22 patients (60%) eventually developed complications, including unilateral (n = 11) or bilateral (n = 3) vocal cord paralysis (38%). Eight patients (22%) had, at some point, an associated benign parathyroid adenoma. Median overall survival was 14.3 yr (range 10.5-25.7 yr) from the date of diagnosis. Factors associated with increased mortality included lymph node or distant metastases, number of recurrences, higher calcium level at recurrence, and a high number of calcium-lowering medications. Factors not associated with mortality included age, race, tumor size, time to first recurrence, and extent of initial operation. Initial operations done at our center had improved survival (P = 0.037) and decreased complication rates (P < 0.001) vs. those done elsewhere.
  
  
  CONCLUSIONS
  Parathyroid cancer patients typically have a long survival, which often includes multiple reoperations for recurrence and thus a high rate of surgical complications. Patients in whom there is a high index of suspicion for parathyroid cancer should be referred to a dedicated endocrine surgery center for their initial operation.
authors.affiliation: Section of Endocrine Surgery, University of California, Los Angeles, California 90095, USA. aharari@mednet.ucla.edu
authors.forename: Avital
authors.initials: A
authors.lastname: Harari
authors.forename: Avantika
authors.initials: A
authors.lastname: Waring
authors.forename: Gustavo
authors.initials: G
authors.lastname: Fernandez-Ranvier
authors.forename: Jimmy
authors.initials: J
authors.lastname: Hwang
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
authors.forename: Elliot
authors.initials: E
authors.lastname: Mitmaker
authors.forename: Wen
authors.initials: W
authors.lastname: Shen
authors.forename: Jessica
authors.initials: J
authors.lastname: Gosnell
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Orlo
authors.initials: O
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D010280:Parathyroid Glands / Q000473:pathology* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome