A nomogram for relapse/death and contemplating adjuvant therapy for parathyroid carcinoma
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Fecha
2023-08
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Título de la revista
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Título del volumen
Editor
Elsevier
ISBN
ISSN
1055-3207
ISSNe
1558-5042
Resumen
The staging systems proposed to date for PC have not been adequately validated. Recent multivariate have been carried out in large national and international databases to search for prognostic factors for survival and relapse in PC. Advanced age, male gender, high PTH and calcium levels at diagnosis, tumor size >30 mm, angioinvasion, presence of distant metastases, and specific tumor microenvironmental factors, such as parafibromin staining and tumor-infiltrating lymphocytes, have been strongly correlated with decreased OS and CSS, and with increased risk of local and distant recurrence. Because of their prognostic significance, these host and tumor factors should be included in any PC staging system. However, there is a need to promote collaborative PC registry plans to collate data on the above prognostic factors as well as new ways in a standardized global registry. Such a resource could be used to stratify patients with PC and identify those at high risk for relapse and death who may benefit from strict surveillance or adjuvant therapeutic care.
PC is an indolent cancer with a high recurrence rate of 3 to 5 years after the first surgical intervention. Progression can remain dormant for decades until patients present with distant metastases. Such heterogeneity and neoplastic latency make OS an ambitious endpoint to achieve, and pursuing OS contradicts the actual needs of patients with this endocrine neoplasm. More relevant endpoints focus on achieving normal blood biochemistry to improve quality of life and intervening to lengthen recurrence/metastasis event-related-free survival. Surgery remains the standard treatment because traditional therapies, such as EBRT and chemotherapy, do not benefit patients with advanced unresectable or metastatic PC, new options are emerging for patients with PC. Genomic and phenotypic profiling can continue to inform personalized therapeutic strategies to expand the clinical options available to patients with PC.
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Citación
Surgical Oncology Clinics of North American, Vol. 32, N°2, (2023) p. 251-269.
Palabras clave
Parathyroid carcinoma, Parathyroid cancer, Parathyroid neoplasms, Molecular targeted therapy, Next-generation sequencing, Immunotherapy
Licencia
Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)