J Clin Endocrinol Metab. 2023 Jun 3:dgad316. doi: 10.1210/clinem/dgad316. Online ahead of print.
ABSTRACT
CONTEXT: Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia, yet long-term (5- and 10-year) recurrence rates after curative surgery have been unclear.
OBJECTIVE: To perform the first systematic review and meta-analysis investigating the long-term recurrence rates of sporadic PHPT after successful parathyroidectomy.
DATA SOURCES: A comprehensive search of multiple databases (including PubMed, EMBASE, Cochrane, EBSCO-CINHAL, EMBASE, Ovid, Scopus, and Google Scholar) was performed from each database’s inception to January 18, 2023.
STUDY SELECTION: Observational studies reporting at least five years of follow-up data after surgical resection were included. Two reviewers independently screened articles for relevance. Of 5,769 articles initially identified, 242 were examined in full-text review and 34 were deemed eligible for inclusion.
DATA EXTRACTION: Two authors independently performed data extraction and study appraisal, using the NIH study quality assessment tools.
DATA SYNTHESIS: Of 30,658 participants, 350 patients (1.1%) experienced recurrence after resection. A meta-analysis of proportions was performed to obtain the pooled recurrence rates. The pooled estimate for overall recurrence rate was 1.56% (95% CI 0.96-2.28%; I2 = 91%). The pooled estimates for 5- and 10- year recurrence rate after resection were 0.23% (0.04-0.53%, 19 studies; I2 = 66%) and 1.03% (0.45-1.80%, 14 studies; I2 = 89%), respectively. Sensitivity analyses did not find a statistically significant difference when adjusting for study size, diagnosis, or surgical approach.
CONCLUSIONS: Approximately 1.56% of sporadic PHPT patients eventually develop recurrence following parathyroidectomy. The initial diagnosis and procedure type does not influence recurrence rates. Consistent long-term follow-up is warranted to help identify recurrent disease.
PMID:37279502 | DOI:10.1210/clinem/dgad316
