A Meta-Analysis Of The Effects Of Surgery On Long-Term Mortality In Patients With Secondary Hyperparathyroidism

Background&Aims: Both parathyroidectomy and drug therapy can effectively reduce serum intact parathyroid hormone(iPTH)in patients with secondary hyperparathyroidism(SHPT),which are the two main treatment modalities for SHPT patients.The aim of this review was to analyze the effects of surgery and pharmacotherapy on long-term survival in people with SHPT using meta-analysis.Methods: Randomized controlled trials and cohort studies comparing surgery and pharmacological treatment of SHPT were identified by systematically searching PubMed,Web of science and Embase.Retrieved studies were screened against strict inclusion and exclusion criteria and the quality of included studies was assessed by using Newcastle-Ottawa Score(NOS).Pooled survival data results were expressed using hazard risk(HR)and its 95% confidence intervals(CI).Subgroup analysis was performed according to the publication time,publication area,sample size,mean age,mean plasma PTH,and average dialysis time of the included study participants,and observed differences between groups.Results: A total of 19 studies were included,including 12 retrospective cohort studies and 7 prospective cohort studies,involving 32237 participants.Pooled results showed that compared with medical therapy,a 27% reduction in all-cause mortality(HR=0.73,95%CI 0.65-0.82,P<0.001)and a 23%(HR=0.77,95% CI 0.64-0.92,P=0.004)reduction in cardiovascular mortality in patients with SHPT after surgery.The results of subgroup analysis showed that the positive effect of surgical treatment on all-cause mortality was not affected by the time of publication,the region of publication,the size of the sample,the mean age of the included participants,the mean plasma PTH level,and the mean duration of dialysis.Conclusion: This article conducts a meta-analysis of existing studies on the effects of surgical treatment and pharmacotherapy on all-cause mortality and cardiovascular event mortality in patients with secondary hyperparathyroidism.Through the analysis of the results of this study,we can draw the following conclusions:(1)Surgery reduces all-cause mortality and cardiovascular event mortality in people with SHPT compared with medical therapy.(2)The effect of surgical treatment in reducing all-cause mortality in patients with SHPT was not affected by the time of publication,place of publication,sample size,study type,mean age of participants,mean plasma PTH level,and mean duration of dialysis.(3)Surgery reduced cardiovascular event mortality in different subgroups,but the results were not statistically significant in the subgroup of the retrospective cohort study,published > 2015,non-Asian population,sample size ≤300,mean age≤50 years,mean plasma PTH level >800 pg/ml.