title: Parathyroid carcinoma in more than 1,000 patients: A population-level analysis.
abstract: BACKGROUND
  Parathyroid carcinoma (PC) is a rare malignancy with a moderate prognosis. The staging system, prognostic indicators, and optimal surgical management are still under debate. This large cohort explores prognostic factors for PC.
  
  
  METHODS
  1,022 cases of PC in the 1998-2011 National Cancer Data Base that underwent surgery were examined for predictors of lower overall survival (OS) and relative risk (RR) of death at 5 years.
  
  
  RESULTS
  The 5-year OS was 81.1% in 528 patients with ≥ 60 months of follow-up. The overall cohort was mainly non-Hispanic (96.5%), white (77.4%), and insured (94.3%), with a median age of 57 years. Mean OS was lower and RR of death greater in older (P < .001), black (P = .007) patients with a secondary malignancy (P = .015) and ≥ 2 comorbidities (P = .005), whose surgical specimen had positive surgical margins (P = .026) or positive lymph nodes (P < .001). Multivariate cox regression demonstrated that positive lymph nodes (hazard ratio [HR], 6.47; 95% CI, 1.81-23.11) and older age (HR, 2.35; 95% CI, 1.25-4.43) were associated with lower OS.
  
  
  CONCLUSIONS
  PC is a rare malignancy with a 5-year OS of 81.1%. Positive lymph nodes and older age predict lower OS and an increased risk of death.
authors.affiliation: Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Claire
authors.initials: C
authors.lastname: Sadler
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Beierle
authors.affiliation: Department of Surgery, Methodist Children's Hospital of South Texas, University of Texas Health Science Center-San Antonio, San Antonio, TX.
authors.forename: John J
authors.initials: JJ
authors.lastname: Doski
authors.affiliation: Department of Surgery, Maine Children's Cancer Program, Tufts University, Portland, ME.
authors.forename: Monica
authors.initials: M
authors.lastname: Langer
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
authors.affiliation: Department of Surgery, John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA. Electronic address: melaniegoldfarbmd@gmail.com.
authors.forename: Melanie
authors.initials: M
authors.lastname: Goldfarb
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology