(A304) Determinants of Survival Outcomes in Parathyroid Carcinoma: Analysis Using NCDB Data

Introduction: Parathyroid carcinoma is a rare endocrine malignancy with significant variability in treatment and outcomes. This study examines survival determinants in patients with parathyroid carcinoma using the National Cancer Database (NCDB). We aimed to evaluate the impact of demographic, socioeconomic, clinical, and treatment factors on survival outcomes.

Methods: A cohort of 1139 parathyroid carcinoma cases from 2004–2022 was analyzed. Demographic data included age, sex, race, insurance type, and income. Clinical variables included tumor size, Charlson-Deyo comorbidity score, surgical margins, and type of surgery. Cox proportional hazards modeling was used to identify predictors of overall survival.

Results: The cohort consisted of 52.3% males and 47.7% females, with a mean age of 57.4. Insurance coverage was dominated by private (50%) and Medicare (32%), with a smaller proportion uninsured (6%). Most tumors were between 11–30mm in size; however, 48% of cases had unknown tumor size. Surgery was performed in 90% of patients, with subtotal or total removal of the primary site being the most common. Negative surgical margins were achieved in 55% of cases, while 14% had macroscopic residual margins.

Cox regression revealed significant survival associations for insurance status, race, tumor size, and Charlson-Deyo comorbidity score. Uninsured patients experienced worse survival (HR: 1.35, p = 0.049), while Medicare coverage was protective (HR: 0.83, p = 0.042). Patients with unknown tumor size had a significantly higher hazard (HR: 2.19, p < 0.001), and higher comorbidity scores (CDCC: 2) were associated with worse outcomes (HR: 1.65, p = 0.019). Race was also a significant predictor, with minority racial groups having worse survival (HR: 3.25, p = 0.002).

Conclusions: Survival in parathyroid carcinoma is significantly influenced by insurance status, tumor size, comorbidity, and race. These findings highlight disparities in care and the need for tailored interventions. Improved documentation of tumor characteristics and equitable access to healthcare may enhance outcomes for this rare malignancy.