Frontiers in endocrinology · 2026
Short-term biochemical outcomes after microwave ablation versus parathyroidectomy for primary hyperparathyroidism: an IPTW analysis.
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Yin Le, Luo Feng, Chai Yalin, Sun Lijie, Luo Congjuan
Аннотация
OBJECTIVE: To compare the short-term biochemical efficacy and safety of microwave ablation (MWA) and parathyroidectomy (PTX) in patients with primary hyperparathyroidism (PHPT), and to identify independent predictors of treatment failure.
MATERIALS AND METHODS: This retrospective cohort study included 173 consecutive patients with PHPT treated with MWA (n = 46) or PTX (n = 127) between January 2019 and January 2025. Covariate-balancing propensity score-derived inverse probability of treatment weighting (CBPS-IPTW) was used to balance baseline characteristics. Longitudinal changes in parathyroid hormone (PTH), calcium, and phosphorus were assessed using IPTW-weighted linear mixed-effects models, whereas biochemical treatment failure and safety outcomes were compared using weighted logistic regression with robust standard errors. IPTW-weighted Kaplan-Meier and Cox analyses were exploratory, and factors associated with treatment failure were evaluated using Firth penalized logistic regression.
RESULTS: After weighting, all covariates were well balanced, with absolute standardized mean differences <0.01. Both treatments produced substantial biochemical improvement. A significant treatment-by-time interaction was observed for PTH (P < 0.001), whereas calcium and phosphorus trajectories did not differ significantly. The weighted risks of treatment failure were 23.8% after PTX and 35.9% after MWA [odds ratio (OR), 1.80; 95% confidence interval (CI), 0.74-4.39], with an absolute risk difference of 12.1 percentage points (95% CI, -7.3 to 31.6). Exploratory Cox analysis showed no significant difference in documented treatment failure (hazard ratio, 1.73; 95% CI, 0.82-3.64). Weighted hypocalcemia risks were 9.2% and 15.5%, respectively (OR, 1.81; 95% CI, 0.50-6.56). Each doubling of baseline PTH was associated with approximately twofold higher odds of treatment failure (OR, 2.02; 95% CI, 1.39-4.09).
CONCLUSION: Both MWA and PTX produced substantial short-term biochemical improvement. No significant difference in 6-month treatment failure was detected after CBPS-IPTW adjustment; however, wide confidence intervals precluded conclusions of equivalence or non-inferiority. Baseline PTH may help identify patients at increased risk of incomplete biochemical response, and MWA may be considered for carefully selected patients.
MATERIALS AND METHODS: This retrospective cohort study included 173 consecutive patients with PHPT treated with MWA (n = 46) or PTX (n = 127) between January 2019 and January 2025. Covariate-balancing propensity score-derived inverse probability of treatment weighting (CBPS-IPTW) was used to balance baseline characteristics. Longitudinal changes in parathyroid hormone (PTH), calcium, and phosphorus were assessed using IPTW-weighted linear mixed-effects models, whereas biochemical treatment failure and safety outcomes were compared using weighted logistic regression with robust standard errors. IPTW-weighted Kaplan-Meier and Cox analyses were exploratory, and factors associated with treatment failure were evaluated using Firth penalized logistic regression.
RESULTS: After weighting, all covariates were well balanced, with absolute standardized mean differences <0.01. Both treatments produced substantial biochemical improvement. A significant treatment-by-time interaction was observed for PTH (P < 0.001), whereas calcium and phosphorus trajectories did not differ significantly. The weighted risks of treatment failure were 23.8% after PTX and 35.9% after MWA [odds ratio (OR), 1.80; 95% confidence interval (CI), 0.74-4.39], with an absolute risk difference of 12.1 percentage points (95% CI, -7.3 to 31.6). Exploratory Cox analysis showed no significant difference in documented treatment failure (hazard ratio, 1.73; 95% CI, 0.82-3.64). Weighted hypocalcemia risks were 9.2% and 15.5%, respectively (OR, 1.81; 95% CI, 0.50-6.56). Each doubling of baseline PTH was associated with approximately twofold higher odds of treatment failure (OR, 2.02; 95% CI, 1.39-4.09).
CONCLUSION: Both MWA and PTX produced substantial short-term biochemical improvement. No significant difference in 6-month treatment failure was detected after CBPS-IPTW adjustment; however, wide confidence intervals precluded conclusions of equivalence or non-inferiority. Baseline PTH may help identify patients at increased risk of incomplete biochemical response, and MWA may be considered for carefully selected patients.