Search for clinical, genetic, morphological and immunohistochemical predictors of parathyroid cancer recurrence

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Background. Currently, there is no consensus on postoperative risk stratification for parathyroid cancer (PC). The risk factors of disease progression are crucial for choosing the optimal treatment strategy, including adjuvant methods and patient,s follow-up. Aim. Identifying predictors of PC recurrence Materials and methods. We performed a retrospective observational study of 85 patients with verified PC divided into remission (n=61) and recurrence (n=19) groups after primary surgical treatment for the period 2004–2023. The analyzed parameters included demographic, laboratory and instrumental data of patients with PC, the presence of a mutation in the CDC73 gene, morphological and immunohistochemical characteristics of the primary tumor. Results. After adjustments for multiple comparisons, a statistically significant association of recurrence was found for preoperative calcium level (p0.001), pT4 stage (p0.001) according to TNM-classification (Tumor, Nodus, Metastasis) American Joint Committee on Cancer 2017. There was a statistical trend for calcium correction for hypoalbuminemia (p=0.002), presence of nephrolithiasis/nephrocalcinosis (p=0.021), parathyroid hormone level 6 months after primary surgery (p0.05), pT3 stage TNM (p=0.007), nuclear expression of parafibromin in tumor tissue (p0.05). We did not reveal any associations between disease recurrence and sex, age, volume of surgical treatment, germline mutation in the CDC73, parafibromin expression and Ki-67 in tumor tissue. Conclusion. Our study revealed several factors of poor prognosis, allowing to identify a risk group for recurrence, which can contribute to active dynamic monitoring and timely treatment.