Background
Methods
Patient selection and data collection
Statistical analysis
Results
Patients and tumor characteristics, surgical extents and outcomes
Number of parathyroid glands in resected specimen | P-value | |||||
---|---|---|---|---|---|---|
Variable | 0 (A) N = 364 | 1 (B) N = 80 | 2 or more (C) N = 10 | Total n = 454 | A versus B | B versus C |
Age | 50.0 ± 12.5 | 52.2 ± 12.8 | 47.7 ± 6.08 | 50.3 ± 12.5 | 0.207 | 0.183 |
Gender | 0.551 | 0.603 | ||||
Male | 81 (22.3%) | 15 (18.7%) | 2 (20%) | 98 (21.6%) | ||
Female | 283 (77.7%) | 65 (81.3%) | 8 (80%) | 356 (78.4%) | ||
Tumor size | 11.5 ± 9.3 | 12.5 ± 7.6 | 13.6 ± 10.8 | 11.7 ± 9.1 | 0.034 | 0.820 |
Tumor multiplicity | 99/364 (27.2%) | 32/80 (40%) | 2/10 (20%) | 133/454 (29.3%) | 0.030 | 0.308 |
Tumor bilaterality | 80/364 (22.0%) | 23/80 (28.8%) | 0 | 103/454 (22.7%) | 0.192 | 0.059 |
Tumor location | 0.212 | 0.150 | ||||
Right | 145 (39.8%) | 23 (28.8%) | 3 (30%) | 171 (37.7%) | ||
Left | 128 (35.2%) | 32 (40%) | 7 (70%) | 167 (36.8%) | ||
Bilateral | 77 (21.2%) | 23 (28.8%) | 0 | 100 (22.0%) | ||
Confined to isthmus | 14 (3.8%) | 2 (2.5%) | 0 | 16 (3.5%) | ||
T classification | 0.045 | 0.109 | ||||
T1 | 203 (55.8%) | 34 (42.5%) | 4 (40.0%) | 241 (53.1%) | ||
T2 | 24 (6.6%) | 3 (3.8%) | 1 (10.0%) | 28 (6.2%) | ||
T3 | 134 (36.8%) | 43 (53.8%) | 4 (40.0%) | 181 (39.9%) | ||
T4 | 3 (0.6%) | 0 | 1 (10.0%) | 4 (0.9%) | ||
N classification | < 0.001 | 0.046 | ||||
N0 | 239 (65.7%) | 35 (43.8%) | 1 (10.0%) | 275 (60.6%) | ||
N1 | 125 (34.3%) | 45 (56.3%) | 9 (90.0%) | 179 (39.4%) | ||
TNM stage | 0.090 | 0.769 | ||||
I | 226 (62.1%) | 39 (48.8%) | 4 (40.0%) | 269 (59.3%) | ||
II | 9 (2.5%) | 1 (1.3%) | 0 | 10 (2.2%) | ||
III | 93 (25.5%) | 27 (33.8%) | 4 (40.0%) | 124 (27.3%) | ||
IV | 36 (9.9%) | 13 (16.3%) | 2 (20.0%) | 51 (11.2%) | ||
Extrathyroidal extension (minimal) | 157/364 (43.1%) | 47/80 (58.8%) | 5/10 (50%) | 209/454 (46.0%) | 0.013 | 0.737 |
Number of parathyroid glands in resected specimen | P-value | |||||
---|---|---|---|---|---|---|
Variable | 0 (A) N = 364 | 1(B) N = 80 | 2 or more (C) N = 10 | Total n = 454 | A versus B | B versus C |
CND | <0.001 | 0.749 | ||||
None | 118 (32.4%) | 4 (5.0%) | 0 | 122 (26.9%) | ||
Unilateral | 91 (25.0%) | 13 (16.3%) | 2 (20.0%) | 106 (23.3%) | ||
Bilateral | 155 (42.6%) | 63 (78.8%) | 8 (80.0%) | 226 (49.8%) | ||
Retrieved CLN (No) | 5.0 ± 5.5 | 7.4 ± 5.2 | 7.7 ± 2.8 | 5.5 ± 5.5 | < 0.001 | 0.641 |
Metastatic CLN (No) | 1.2 ± 2.6 | 2.1 ± 3.3 | 2.3 ± 2.8 | 1.4 ± 2.8 | 0.001 | 0.748 |
Lateral ND | 51/364 (14.0%) | 18/80 (22.5%) | 2/10 (20%) | 71/454 (15.6%) | 0.062 | 0.610 |
Operation time (minutes) | 162.2 ± 73.7 | 179.1 ± 93.6 | 198.0 ± 142.5 | 166.0 ± 79.6 | 0.218 | 0.651 |
PTH, preop | 38.35 ± 15.06 | 39.13 ± 14.09 | 34.23 ± 12.37 | 38.38 ± 14.81 | 0.701 | 0.432 |
PTH, postop 1 day | 14.77 ± 11.82 | 11.71 ± 8.90 | 11.95 ± 11.32 | 14.15 ± 11.32 | 0.062 | 0.716 |
PTH, postop 1 week | 21.39 ± 13.46 | 18.89 ± 11.12 | 17.07 ± 9.13 | 20.86 ± 13.02 | 0.125 | 0.813 |
PTH, postop 6 months | 32.54 ± 15.04 | 31.25 ± 15.33 | 26.22 ± 14.87 | 32.11 ± 15.10 | 0.378 | 0.346 |
Dec. ratio, postop 1 day | 58.65 ± 33.43 | 63.54 ± 35.55 | 67.55 ± 15.98 | 59.74 ± 33.49 | 0177 | 0.722 |
Dec. ratio, postop 1 week | 40.52 ± 38.23 | 49.45 ± 24.49 | 41.39 ± 38 | 41.39 ± 38.63 | 0.248 | 0.910 |
Dec. ratio, postop 6 months | 7.09 ± 53.72 | 13.24 ± 50.51 | 21.49 ± 43.53 | 8.71 ± 52.80 | 0.124 | 0.813 |
Hypoparathyroidism | ||||||
Temporary | 194/364 (53.3%) | 53/80 (66.3%) | 7/10 (70%) | 254 (55.9%) | 0.010 | 0.697 |
Permanent | 13/364 (3.6%) | 6/80 (7.5%) | 1/10 (10%) | 20 (4.4%) | 0.128 | 0.575 |
IV calcium administration | 27/364 (7.4%) | 10/80 (12.5%) | 3/10 (30%) | 40/454 (8.8%) | 0.177 | 0.155 |
Vocal cord paralysis | 0.787 | 0.093 | ||||
None | 351 (96.2%) | 77 (96.3%) | 8 (80%) | 436 (96.0%) | ||
Temporary | 12 (3.3%) | 3 (3.8%) | 2 (20%) | 17 (3.7%) | ||
Permanent | 1 (0.3%) | 0 | 0 | 1 (0.2%) | ||
Hematoma | 15/364 (4.1%) | 4/80 (5%) | 0 | 19/454 (4.2%) | 0.760 | 0.619 |
Variable | β Coef | SE | P-value | OR | 95% (lower) | 95% (upper) |
---|---|---|---|---|---|---|
Tumor size | -0.016 | 0.016 | 0.337 | 0.985 | 0.954 | 1.016 |
Tumor multiplicity | 0.232 | 0.282 | 0.411 | 1.261 | 0.726 | 2.190 |
T classification (advanced) | 0.367 | 0.400 | 0.359 | 1.443 | 0.659 | 3.159 |
N classification | 0.204 | 0.339 | 0.546 | 1.227 | 0.631 | 2.384 |
Minimal ETE | 0.057 | 0.408 | 0.888 | 1.059 | 0.476 | 2.356 |
Excised central LN (No) | -0.004 | 0.030 | 0.890 | 0.996 | 0.939 | 1.056 |
Metastatic central LN (No) | 0.011 | 0.054 | 0.845 | 1.011 | 0.909 | 1.123 |
CND | 0.000 | |||||
Unilateral | 1.306 | 0.611 | 0.033 | 3.691 | 1.115 | 12.222 |
Bilateral | 2.228 | 0.585 | 0.000 | 9.280 | 2.950 | 29.198 |
Hypoparathyroidism | 0.077 | |||||
Transient | 0.556 | 0.296 | 0.061 | 1.743 | 0.976 | 3.116 |
Permanent | 1.083 | 0.597 | 0.070 | 2.952 | 0.917 | 9.507 |
Factors affecting hypoparathyroidism
Factors | Transient hypoparathyroidism | P-value | |
---|---|---|---|
No n = 180 | Yes n = 254 | ||
Age | 51.8 ± 12.4 | 49.6 ± 12.5 | 0.075 |
Gender | 0.411 | ||
Male | 43 (23.9%) | 52 (20.5%) | |
Female | 137 (76.1%) | 202 (79.5%) | |
Tumor size (mm) | 12.1 ± 9.7 | 11.4 ± 8.6 | 0.398 |
Tumor location | 0.899 | ||
Right | 69 (38.3%) | 97 (38.2%) | |
Left | 64 (35.6%) | 97 (38.2%) | |
Bilateral | 41 (22.8%) | 51 (20.1%) | |
Confined to isthmus | 6 (3.3%) | 9 (3.5%) | |
Tumor multiplicity | 55/180 (3.6%) | 72/254 (28.3%) | 0.669 |
Tumor bilaterality | 44/180 (24.4%) | 52/254 (20.5%) | 0.349 |
Preserved PTG number | 0.025 | ||
4 | 157 (87.2%) | 194 (76.4%) | |
3 | 21 (11.75) | 53 (20.9%) | 0.010 |
2 | 1 (0.6%) | 5 (2.0%) | 0.470 |
1 | 1 (0.6%) | 2 (0.8%) | 0.583 |
Incidental parathyroidectomy | 23/180 (12.8%) | 60/254 (23.6%) | 0.004 |
T classification | 0.123 | ||
T1 | 98(54.4%) | 136(53.5%) | |
T2 | 15(8.3%) | 11(4.3%) | |
T3 | 64(35.6%) | 106(41.7%) | |
T4 | 3(1.7%) | 1(0.4%) | |
N classification | 0.422 | ||
N0 | 116(64.4%) | 153(60.2%) | |
N1 | 64(35.6%) | 101(39.8%) | |
TNM stage | 0.212 | ||
I | 100(55.6%) | 158(62.2%) | |
II | 7(3.9%) | 3(1.2%) | |
III | 52(28.9%) | 65(25.6%) | |
IV | 21(11.7%) | 28(11.0%) | |
Extrathyroidal extension (minimal) | 79/180 (43.9%) | 118/254 (46.5%) | 0.625 |
CND (bilateral versus unilateral) | 79/122(64.8%) | 137/194(70.6%) | 0.320 |
CND (yes versus no) | 122/180 (67.8%) | 194/254 (76.4%) | 0.031 |
Lateral ND | 26/180 (14.4%) | 39/254 (15.4%) | 0.892 |
Lateral LN metastasis | 0.275 | ||
None | 161 (89.4%) | 218 (85.8%) | |
Unilateral | 13 (7.2%) | 30 (11.8%) | |
Bilateral | 6 (3.3%) | 6 (2.4%) | |
Operation time (minutes) | 160 ± 74 | 170 ± 84 | 0.215 |
Retrieved central LN (No) | 4.6 ± 5.1 | 6.0 ± 5.6 | 0.007 |
Metastatic central LN (No) | 1.0 ± 2.0 | 1.6 ± 3.2 | 0.016 |
Amount of drainage (mL) | 224 ± 787 | 225 ± 619 | 0.985 |
Vocal cord paralysis | 0.679 | ||
None | 172(95.6%) | 244(96.1%) | |
Temporary | 7(3.9%) | 10(3.9%) | |
Permanent | 1(0.6%) | 0 | |
Hematoma | 8/180(4.4%) | 11/254(4.3%) | 0.567 |
Permanent hypoparathyroidism | P-value | ||
---|---|---|---|
Factors | No n = 434 | Yes n = 20 | |
Age | 50.5 ± 12.5 | 46.3 ± 12.2 | 0.059 |
Gender | 0.587 | ||
Male | 95 (21.9%) | 3 (15.0%) | |
Female | 339(78.1%) | 17 (85.0%) | |
Tumor size (mm) | 11.7 ± 9.1 | 12.9 ± 8.9 | 0.367 |
Tumor location | 0.180 | ||
Right | 166 (38.2%) | 5 (25.0%) | |
Left | 161 (37.1%) | 6 (30.0%) | |
Bilateral | 92 (21.2%) | 8 (40.0%) | |
Confined to isthmus | 15 (3.5%) | 1 (5.0%) | |
Tumor multiplicity | 127/434 (29.3%) | 6/20 (30.0%) | 0.559 |
Tumor bilaterality | 96/434 (22.1%) | 7/20 (35.0%) | 0.179 |
Preserved PTG number | 0.147 | ||
4 | 351 (80.9%) | 13 (65.0%) | |
3 | 74 (17.1%) | 6 (30.0%) | |
2 | 6 (1.4%) | 1 (5.0%) | |
1 | 3 (0.7%) | 0 | |
Incidental parathyroidectomy | 83/434 (19.1%) | 7/20 (35.0%) | 0.090 |
T classification | 0.285 | ||
T1 | 234(53.9%) | 7(35.0%) | |
T2 | 26(6.0%) | 2(10.0%) | |
T3 | 170(39.2%) | 11(55.0%) | |
T4 | 4(0.9%) | 0 | |
N classification | 0.008 | ||
N0 | 269(62.0%) | 6(30.0%) | |
N1 | 165(38.0%) | 14(70.0%) | |
TNM staging | 0.871 | ||
I | 258 (59.4%) | 11(55.0%) | |
II | 10 (2.3%) | 0 | |
III | 117 (27.0%) | 7(35.0%) | |
IV | 49 (11.3%) | 2(10.0%) | |
Extrathyroidal extension (minimal) | 197/434(45.4%) | 12/20(60.0%) | 0.253 |
CND | 0.663 | ||
None | 118 (27.2%) | 4 (20.0%) | |
Unilateral | 100 (23.0%) | 6 (30.0%) | |
Bilateral | 216 (49.8%) | 10 (50.0%) | |
Lateral ND | 65/434 (15.0%) | 6/20 (30.0%) | 0.106 |
Lateral LN metastasis | 0.683 | ||
None | 379 (87.3%) | 17 (85.0%) | |
Unilateral | 43 (9.9%) | 3 (15.0%) | |
Bilateral | 12 (2.8%) | 0 | |
Operation time (minutes) | 186.1 ± 80.0 | 183.5 ± 74.5 | 0.841 |
Retrieved central LN (no) | 5.5 ± 5.4 | 6.2 ± 6.6 | 0.743 |
Metastatic central LN (no) | 1.4 ± 2.8 | 1.5 ± 2.4 | 0.355 |
Drain amount (mL) | 224.7 ± 692.8 | 151.8 ± 152.4 | 0.188 |
Vocal cord paralysis | 1.000 | ||
None | 416(95.9%) | 20(100%) | |
Temporary | 17(3.9%) | 0 | |
Permanent | 1(0.2%) | 0 | |
Hematoma | 19/434(4.4%) | 0 | 1.000 |