Stage and age as distinct determinants of competing mortality in parathyroid carcinoma: a population-based analysis
Endocrine, cilt.91, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 91 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s12020-026-04782-6
- Dergi Adı: Endocrine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE, MEDLINE, Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Cardiovascular mortality, Cause-specific mortality, Competing risks, Fine–Gray model, Parathyroid carcinoma, SEER
- Süleyman Demirel Üniversitesi Adresli: Evet
Özet
Purpose: Parathyroid carcinoma is a rare endocrine malignancy in which much of the long-term morbidity relates to chronic hypercalcemia. Conventional survival analyses treat deaths from causes other than the cancer as censoring events, which can distort estimates of cause-specific risk. We applied competing-risk methodology to characterize cause-specific mortality and to determine whether distinct clinical factors differentially influence cancer-specific and cardiovascular/renal mortality. Methods: Patients with malignant parathyroid carcinoma (primary site C75.0) were identified from the SEER Research Data, 17 Registries, November 2023 submission (2000–2021). Cause-specific, cardiovascular/renal, and other-cause deaths were defined a priori as competing events. Cumulative incidence functions were estimated using the Aalen–Johansen estimator, compared with Gray’s test, and modeled with Fine–Gray subdistribution hazard regression, adjusting for age, sex, race, and stage. Results: Among 656 patients (median follow-up, 86 months), 213 died: 61 (9.3%) from cancer-specific causes, 68 (10.4%) from cardiovascular/renal causes, and 84 (12.8%) from other causes. Cancer-specific mortality plateaued after roughly a decade (15-year cumulative incidence, 11.0%), whereas cardiovascular/renal mortality continued to rise (12.3%) and ultimately exceeded it. In multivariable Fine–Gray models, advanced (regional/distant) stage was independently associated with cancer-specific death (subdistribution hazard ratio [sHR], 3.37; 95% CI, 1.72–6.60) but not cardiovascular/renal death, whereas age ≥ 60 years was independently associated with cardiovascular/renal death (sHR, 2.43; 95% CI, 1.49–3.96) but not cancer-specific death. Conclusions: Cancer-specific and cardiovascular/renal mortality follow distinct competing-risk trajectories in parathyroid carcinoma, with stage primarily determining cancer-specific mortality and age primarily determining cardiovascular/renal mortality. These findings support consideration of competing-risk profiles when planning long-term surveillance, including cardiovascular and renal follow-up.