Abstract
Purpose
To establish if parathyroidectomy is beneficial for patient-reported outcomes (PROs), including quality of life (QoL), of patients with mild hypercalcemia ( < 1.0 mg/dl above the upper limit of reference ranges) caused by primary hyperparathyroidism without classic symptoms (mild PHPT).
Methods
We conducted a systematic review of the literature. Prospective studies were selected if PROs were measured before and after surgery and if the subpopulation of mild PHPT was clearly defined. Selected studies were appraised for their designs, PRO measures, and potential biases, as well as findings. Effect sizes were estimated to evaluate the extent of the benefits, if possible.
Results
Four randomized controlled trials and six observational studies were included in this analysis. Seven studies used the SF-36 to measure QoL and the other three used different scales. Quantitative data on outcomes were provided in the four observational studies, but effect sizes could not be estimated. A placebo effect of surgery was discussed in five studies. Statistically significant improvements in PROs were observed in all studies, but the clinical importance of the changes was not discussed in detail.
Conclusions
The surgical treatment of mild PHPT may be associated with improved PROs, but the clinical significance of the changes is not yet confirmed.
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References
Walker MD, Silverberg SJ. Parathyroidectomy in asymptomatic primary hyperparathyroidism: Improves “bones” but not “psychic moans.” J Clin Endocrinol Metab. 2007;92:1613–5.
Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98:1122–9.
Coe FL, Favus MJ. Does mild, asymptomatic hyperparathyroidism require surgery? N Engl J Med. 1980;302:224–5.
Niederle B, Wemeau JL. Is surgery necessary for 'mild' or 'asymptomatic' hyperparathyroidism? Eur J Endocrinol. 2015;173:D13–D20.
Griebeler ML, Kearns AE, Ryu E, Hathcock MA, Melton LJ III, Wermers RA. Secular trends in the incidence of primary hyperparathyroidism over five decades (1965–2010). Bone. 2015;73:1–7.
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3561–9.
Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, et al. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3580–94.
Ospina NS, Maraka S, Rodriguez-Gutierrez R, Espinosa de Ycaza AE, Jasim S, Gionfriddo M, et al. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis. Osteoporos Int. 2016;27:3395–407.
U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research and U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance. Health and Quality of Life Outcomes. 2006;4:79 doi:10.1186/1477-7525-4-79.
Snyder CF, Aaronson NK. Use of patient-reported outcomes in clinical practice. Lancet. 2009;374:369–70.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–122.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Bilezikian J, Potts J, Fuleihan G, Kleerekoper M, Neer R, Peacok M, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21th century. J Clin Endocrinol Metab. 2002;87:5353–61.
Ellis PD. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge: Cambridge University Press; 2010.
Okamoto T, Gerstein HC, Obara T. Psychiatric symptoms, bone density and non-specific symptoms in patients with mild hypercalcemia due to primary hyperparathyroidism: a systematic overview of the literature. Endocr J. 1997;44:367–74.
Coker LH, Rorie K, Cantley L, Kirkland K, Stump D, Burbank N, et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg. 2005;242:642–50.
Brito K, Edirimanne S, Eslick GD. The extent of improvement of health-related quality of life as assessed by the SF36 and Paseika scales after parathyroidectomy in patients with primary hyperparathyroidism–a systematic review and meta-analysis. Int J Surg. 2015;13:245–9.
Cheng SP, Lee JJ, Liu TP, Yang PS, Liu SC, Hsu YC, et al. Quality of life after surgery or surveillance for asymptomatic primary hyperparathyroidism: a meta-analysis of randomized controlled trials. Medicine. 2015;94:e931.
Rao DS, Phillips ER, Divine GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2004;89:5415–22.
Bollerslev J, Jansson S, Mollerup CL, Nordenström J, Lundgren E, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab. 2007;92:1687–92.
Ambrogini E, Cetani F, Cianferotti L, Vignail E, Banti C, et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab. 2007;92:3114–211.
Perrier ND, Balachandran D, Wefel JS, Jimenez C, Busaidy N, et al. Prospective, randomized, controlled trial of parathyroidectomy versus observation in patients with “asymptomatic” primary hyperparathyroidism. Surgery. 2009;146:1116–22.
Edwards ME, Rotramel A, Beyer T, Gaffud MJ, Djuricin G, Loviscek K, et al. Improvement in the health-related quality-of-life symptoms of hyperparathyroidism is durable on long-term follow-up. Surgery. 2006;140:655–64.
Caillard C, Sebag F, Mathonnet M, Gibelin H, Brunaud L, Loudot C, et al. Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery. 2007;141:153–60.
Blanchard C, Mathonnet M, Sebag F, Caillard C, Kubis C, Drui D, et al. Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study. Ann Surg Oncol. 2014;21:3534–40.
Ryhänen EM, Heiskanen I, Sintonen H, Välimäki MJ, Roine RP, Schalin-Jäntti C. Health-related quality of life is impaired in primary hyperparathyroidism and significantly improves after surgery: a prospective study using the 15D instrument. Endocr Connect. 2015;4:179-86.Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, et al. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015;158:837-45.
Zanocco K, Butt Z, Kaltman D, Elaraj D, Cella D, Holl JL, et al. Improvement in patient-reported physical and mental health after parathyroidectomy for primary hyperparathyroidism. Surgery. 2015;158:837–45.
Bannani S, Christou N, Guérin C, Hamy A, Sebag F, Mathonnet M, et al. Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism. Br J Surg. 2018;105:223–9.
Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407-15.
Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR, and the Clinical Significance Consensus Meeting Group. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77:371-83.
Streiner DL, Norman GR, Cairney J. Health Measurement Scales: A practical guide to their development and use. 5th Ed, Oxford University Press, 2015, p 268-9.
Norman GR, Sridhar FG, Guyatt GH, Walter SD. Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Med Care. 2001;39:1039–47.
Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–92.
Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med. 2003;348:1839–54.
Pasieka JL, Parsons LL. Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg. 1998;22:513-8; discussion 518-9.
Pasieka JL, Parsons LL, Demeure MJ, Wilson S, Malycha P, Jones J, et al. Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg. 2002;26:942–9.
Webb SM, Puig-Domingo M, Villabona C, Muñoz-Torres M, Farrerons J, Badia X. Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism. Health Qual Life Outcomes. 2013;11:97. https://doi.org/10.1186/1477-7525-11-97.
Webb SM, Puig-Domingo M, Villabona C, Muñoz-Torres M, Marazuela M, Fernández D, et al. Validation of PHPQoL, a disease-specific quality-of-life questionnaire for patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2016;101:1571–8.
Joborn C, Hetta J, Lind L, Rastad J, Akerström G, Ljunghall S. Self-rated psychiatric symptoms in patients operated on because of primary hyperparathyroidism and in patients with long-standing mild hypercalcemia. Surgery. 1989;105:72–8.
Beecher HK. Ethics and experimental therapy. JAMA. 1963;186:858–9.
Stirrat GM, Farndon J, Farrow SC, Dwyer N. The challenge of evaluating surgical procedures. Ann R Coll Surg Engl. 1992;74:80–4.
Fish RG, Crymes TP, Lovell M. Internal-mammary-artery ligation for angina pectoris: its failure to produce relief. N Engl J Med. 1958;259:418–20.
Cobb LA, Thomas GI, Dillard DH, Merendino KA, Bruce RA. An evaluation of internalmammary-artery ligation by a double-blind technic. N Engl J Med. 1959;260:1115–8.
Vergnes JN, Marchal-Sixou C, Nabet C, Maret D, Hamel O. Ethics in systematic reviews. J Med Ethics. 2010;36:771–4.
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Since the present study used information from published articles only and did not procure any data at the individual patient level, ethical approval was not required [44].
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Kiyomi Horiuchi and the co-authors have no conflicts of interest to declare.
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Horiuchi, K., Yoshida, Y. & Okamoto, T. Effects of surgery on the patient-reported outcomes of primary hyperparathyroidism patients with mild hypercalcemia without classic symptoms: a systematic review of the literature. Surg Today 50, 650–656 (2020). https://doi.org/10.1007/s00595-019-01830-9
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DOI: https://doi.org/10.1007/s00595-019-01830-9