Recurrence after Surgery for Primary Hyperparathyroidism in 517 Patients with Multiple Endocrine Neoplasia Type 1. An AFCE and GTE study (Association Francophone de Chirurgie Endocrinienne and Groupe d'étude des Tumeurs Endocrines).
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
03 Jul 2023
03 Jul 2023
Historique:
medline:
30
6
2023
pubmed:
30
6
2023
entrez:
30
6
2023
Statut:
aheadofprint
Résumé
To assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in MEN1 patients and to identify the risk factors for recurrence after initial surgery. In MEN 1 patients, pHPT is multiglandular and the optimal extent of initial parathyroid resection influences the risk of recurrence. MEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal (LTSP) and subtotal (STP) were analyzed. Patients with total parathyroidectomy (TP) with reimplantation were excluded. 517 patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher following LTSP (68.5%) than STP (45%) (P<0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years (P<0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (Odds Ratio=2.19; 95% CI [1.31; 3.69] P=0.003). The five and ten-year recurrent pHPT probabilities were significantly higher in patients after LTSP with mutation in exon 10 (37% and 79% versus 30% and 61% P=0.016). Persistence, recurrence of pHPT and reoperation rate are significantly lower after STP than LTSP in MEN 1 patients. Genotype seems to be associated with recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP and LTSP may not be recommended when exon 10 is mutated.
Sections du résumé
OBJECTIVE
OBJECTIVE
To assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in MEN1 patients and to identify the risk factors for recurrence after initial surgery.
SUMMARY BACKGROUND DATA
BACKGROUND
In MEN 1 patients, pHPT is multiglandular and the optimal extent of initial parathyroid resection influences the risk of recurrence.
METHODS
METHODS
MEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal (LTSP) and subtotal (STP) were analyzed. Patients with total parathyroidectomy (TP) with reimplantation were excluded.
RESULTS
RESULTS
517 patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher following LTSP (68.5%) than STP (45%) (P<0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years (P<0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (Odds Ratio=2.19; 95% CI [1.31; 3.69] P=0.003). The five and ten-year recurrent pHPT probabilities were significantly higher in patients after LTSP with mutation in exon 10 (37% and 79% versus 30% and 61% P=0.016).
CONCLUSION
CONCLUSIONS
Persistence, recurrence of pHPT and reoperation rate are significantly lower after STP than LTSP in MEN 1 patients. Genotype seems to be associated with recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP and LTSP may not be recommended when exon 10 is mutated.
Identifiants
pubmed: 37389888
doi: 10.1097/SLA.0000000000005980
pii: 00000658-990000000-00533
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.