{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:13:20Z","timestamp":1787026400301,"version":"build-2736575974"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pheochromocytomas and paragangliomas (PPGLs) frequently metastasize to bone. We aimed to investigate the clinical characteristics of PPGL patients with postoperative bone metastases (BMs) in hopes of providing valuable insights into future clinical practices for patients with PPGLs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, 107 patients were enrolled. The clinical, pathological and laboratory examination results of the patients were analyzed. We statistically investigated the clinical characteristics of BMs in PPGLs. Logistic regression analysis was used to determine the factors influencing BMs, and a Cox proportional hazards regression model was used to evaluate the prognostic factors of bone metastasis-free survival (BMFS) in patients with PPGLs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty-one of the 107 patients (75.7%) developed BMs, and BMs occurred at a median of 60 months after complete resection of the primary mass (range, 3\u2013308 months). Most bone lesions were multiple (54 patients [66.7%]), and the spine was the most frequent site of bone involvement (229 lesions [63.3%]). Skeletal complications occurred in 31 patients (38.3%), of whom bone pain was the most common symptom (90.3%). Fifty-eight patients were grouped according to whether they had bone metastases or not. Logistic regression analysis revealed that SDHB mutation (OR\n                      <jats:italic>=<\/jats:italic>\n                      5.334, 95% CI: 1.072\u201326.534\n                      <jats:italic>, P=<\/jats:italic>\n                      0.041) was an independent risk factor for bone metastases in PPGLs. The median duration of bone metastasis-free survival in the 58 patients with PPGLs was 101 months (range, 3\u2013308 months). Multivariate Cox regression analysis revealed that SDHB mutation (HR=3.376, 95% CI: 1.470\u20137.754,\n                      <jats:italic>P<\/jats:italic>\n                      =0.004) was an independent poor prognostic factor for BMFS in patients with PPGLs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PPGLs exhibit a pronounced tropism for bone, metastasizing to the skeletal system with higher frequency than to organs like the liver or lungs. These bone metastases are frequently associated with skeletal complications. SDHB mutation is a risk factor for bone metastases in PPGLs. It is crucial to emphasize genetic detection and postoperative follow-up examinations in patients with PPGLs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1657202","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T14:56:27Z","timestamp":1762872987000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of the clinical characteristics of bone metastases after pheochromocytoma\/paraganglioma surgery"],"prefix":"10.3389","volume":"16","author":[{"given":"Longmin","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujun","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiayang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s12022-022-09704-6","article-title":"Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr Pathol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1210\/endrev\/bnab019","article-title":"Personalized management of pheochromocytoma and paraganglioma","volume":"43","author":"N\u00f6lting","year":"2022","journal-title":"Endocr Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"101116","DOI":"10.1016\/j.currproblcancer.2024.101116","article-title":"Management of metastatic pheochromocytomas and paragangliomas: when and what","volume":"51","author":"Sukrithan","year":"2024","journal-title":"Curr Probl Cancer"},{"key":"B4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40618-020-01344-z","article-title":"Management and outcome of metastatic pheochromocytomas\/paragangliomas: an overview","volume":"44","author":"De Filpo","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.3390\/cancers11101505","article-title":"Current management of pheochromocytoma\/paraganglioma: A guide for the practicing clinician in the era of precision medicine","volume":"11","author":"N\u00f6lting","year":"2019","journal-title":"Cancers (Basel)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-020-0531-0","article-title":"Recent advances in the management of pheochromocytoma and paraganglioma","volume":"43","author":"Tanabe","year":"2020","journal-title":"Hypertens Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112137-20230820-00271","article-title":"Clinical features of patients with metastatic pheochromocytoma\/paraganglioma","volume":"104","author":"Cui","year":"2024","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.574662","article-title":"Genetic and clinical profiles of pheochromocytoma and paraganglioma: A single center study","volume":"11","author":"Ma","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.35.1.157","article-title":"Epidemiology and prognosis of pheochromocytoma\/paraganglioma in Korea: a nationwide study based on the National Health Insurance Service","volume":"35","author":"Kim","year":"2020","journal-title":"Endocrinol Metab (Seoul)"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnae001","article-title":"Imaging of pheochromocytomas and paragangliomas","volume":"45","author":"Timmers","year":"2024","journal-title":"Endocr Rev"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2024.02.014","article-title":"Management of pheochromocytomas and paragangliomas","volume":"104","author":"Passman","year":"2024","journal-title":"Surg Clin North Am"},{"key":"B12","doi-asserted-by":"publisher","first-page":"348\u201353","DOI":"10.1016\/j.eprac.2020.09.015","article-title":"Differences in clinical manifestations and tumor features between metastatic pheochromocytoma\/paraganglioma patients with and without germline SDHB mutation","volume":"27","author":"Cui","year":"2021","journal-title":"Endocr Pract"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-229621","article-title":"Thoracic spine metastasis presenting 18 years after complete resection of a phaeochromocytoma","volume":"12","author":"Fadiga","year":"2019","journal-title":"BMJ Case Rep"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4231","article-title":"BM and skeletal-related events in patients with Malignant pheochromocytoma and sympathetic paraganglioma","volume":"98","author":"Ayala-Ramirez","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2024.114122","article-title":"Adverse skeletal related events in patients with bone-metastatic pheochromocytoma\/paraganglioma","volume":"208","author":"Lagan\u00e0","year":"2024","journal-title":"Eur J Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1946","article-title":"Clinical risk factors for Malignancy and overall survival in patients with pheochromocytomas and sympathetic paragangliomas: primary tumor size and primary tumor location as prognostic indicators","volume":"96","author":"Ayala-Ramirez","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1087506","article-title":"Clinical differences between small and large pheochromocytomas and paragangliomas","volume":"14","author":"Zhao","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02239-5","article-title":"Novel alternative tools for metastatic pheochromocytomas\/paragangliomas prediction","volume":"47","author":"Cui","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B19","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/joim.13791","article-title":"Preoperative prediction of metastatic pheochromocytoma and paraganglioma using clinical, genetic, and biochemical markers: A cohort study","volume":"296","author":"Park","year":"2024","journal-title":"J Intern Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-021-02222-9","article-title":"Malignant prediction in paragangliomas: analysis for clinical risk factors","volume":"406","author":"Torres-Costa","year":"2021","journal-title":"Langenbecks Arch Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"500017","DOI":"10.1016\/j.remnie.2024.500017","article-title":"Radio theranostics in paragangliomas and pheochromocytomas","volume":"43","author":"Prado Wohlwend","year":"2024","journal-title":"Rev Esp Med Nucl Imagen Mol (Engl Ed)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/MED.0000000000000724","article-title":"Supportive management of patients with pheochromocytoma\/paraganglioma undergoing noninvasive treatment","volume":"29","author":"Talvacchio","year":"2022","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s11033-020-05684-0","article-title":"BM: a comprehensive review of the literature","volume":"47","author":"Migliorini","year":"2020","journal-title":"Mol Biol Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s12149-021-01685-6","article-title":"Prognostic factors for refractory pheochromocytoma and paraganglioma after 131I-metaiodobenzylguanidine therapy","volume":"36","author":"Hiromasa","year":"2022","journal-title":"Ann Nucl Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000001792","article-title":"The north american neuroendocrine tumor society consensus guidelines for surveillance and management of metastatic and\/or unresectable pheochromocytoma and paraganglioma","volume":"50","author":"Fishbein","year":"2021","journal-title":"Pancreas"},{"key":"B26","doi-asserted-by":"publisher","first-page":"952","DOI":"10.3390\/jcm8070952","article-title":"A clinical efficacy of PRRT in patients with advanced, nonresectable, paraganglioma-pheochromocytoma, related to SDHx gene mutation","volume":"8","author":"Kolasinska-\u0106wik\u0142a","year":"2019","journal-title":"J Clin Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgae252","article-title":"Approach to the patient: concept and application of targeted radiotherapy in the paraganglioma patient","volume":"109","author":"Pacak","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02828-3","article-title":"Targeted molecular medicine: advances in the treatment of metastatic phaeochromocytoma and paraganglioma","volume":"403","author":"Naruse","year":"2024","journal-title":"Lancet"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.7150\/thno.91268","article-title":"Peptide receptor radionuclide therapy combinations for neuroendocrine tumours in ongoing clinical trials: status 2023","volume":"14","author":"di Santo","year":"2024","journal-title":"Theranostics"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1530\/JME-22-0167","article-title":"Genetic bases of pheochromocytoma and paraganglioma","volume":"70","author":"Casc\u00f3n","year":"2023","journal-title":"J Mol Endocrinol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1530\/ERC-22-0375","article-title":"Nuclear medicine in pheochromocytoma and paraganglioma: at a crossroads with precision medicine","volume":"30","author":"Ta\u00efeb","year":"2023","journal-title":"Endocr Relat Cancer"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1657202\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T14:56:28Z","timestamp":1762872988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1657202\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":31,"alternative-id":["10.3389\/fendo.2025.1657202"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1657202","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]},"article-number":"1657202"}}