Abstract
BACKGROUND: Parathyroid carcinoma (PC) is a rare endocrine malignancy, and its preoperative diagnosis remains challenging. This study aimed to evaluate the differential diagnostic value of complete blood count (CBC) parameters for parathyroid tumors. METHODS: A total of 68 patients with PC and 340 patients with parathyroid adenoma (PA) were enrolled in this retrospective study. Preoperative CBC results and follow-up data concerning patient outcomes were collected. Logistic regression (LR), machine learning, and Cox regression models were constructed to investigate the diagnostic and prognostic value of CBC parameters. RESULTS: In the PC group, the white blood cell (WBC) count, monocyte (MON) count, neutrophil (NEU) count, basophil percentage (BAS%), neutrophil percentage (NEU%), and neutrophil-to-lymphocyte ratio (NLR) in peripheral blood samples were significantly higher than those in the PA group (P<0.05). In contrast, the red blood cell (RBC) count, hematocrit (HCT), basophil (BAS) count, lymphocyte percentage (LYM%), mean platelet volume (MPV), eosinophil percentage (EOS%), and lymphocyte-to-monocyte ratio (LMR) were significantly lower in the PC group (P<0.05). The diagnostic factors for PC were RBC count [odds ratio (OR) 0.443; 95% confidence interval (CI): 0.243-0.809], BAS count (OR 0.000; 95% CI: 0.000-0.001), BAS% (OR 12.314; 95% CI: 3.567-42.514), EOS% (OR 0.732; 95% CI: 0.571-0.937), and NEU count (OR 1.445; 95% CI: 1.139-1.833) (P<0.05). The area under the curve (AUC) was 0.870. When these features were combined with clinical features, the AUC of the model increased to 0.946. For patients with PC, high mean corpuscular hemoglobin concentration (MCHC) (P=0.02), parafibromin staining loss (P=0.003), and high parathyroid hormone (PTH) (P=0.02) were independent risk factors for recurrence. CONCLUSIONS: CBC parameters may be useful adjunct markers for the differential diagnosis of PC. They can improve the diagnostic efficiency of clinical parameters for PC.