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Objective To evaluate the clinical characteristics and preoperative predictive factors in patients with parathyroid carcinoma. Methods From January 2010 to December 2016, 150 patients with pathologically and biochemically confirmed primary hyperparathyroidism were enrolled in this study. The clinical data were reviewed to define 28 cases of parathyroid hyperplasia, 14 cases of parathyroid carcinoma (PC), and 108 cases of parathyroid adenoma (PA). The clinical characteristics between PC and PA group were compared and analyzed to explore predictive factors for PC. Results Patients in PC group were significantly younger than those in PA group (47.9±13.9 vs 57.2±14.6 years, P=0.026). The diameter of tumor in PC group was larger than that in PA group (3.6±1.8 vs 2.2±1.4 cm, P =0.005). The levels of albumin-corrected serum calcium, parathyroid hormone (PTH), and alkaline phosphatase (AKP) were all higher in PC group than those in PA group (3.4±0.6 vs 2.9±0.3 mmol/l; 1 157.1 vs 201.6 pg/ml; 168 vs 97 IU/L； all P<0.05). PC correlated with age( r = -0.241, P = 0.007) , albumin-corrected serum calcium (r = 0.324, P<0.001) , PTH levels ( r = 0.301, P = 0.001) , serum AKP ( r = 0.217, P =0.019) and tumor size( r = 0.238, P = 0.011). Receiver operator characteristic curve analysis showed that the optimum cut-off values as follows ： albumin-corrected serum calcium 3.15 mmoL/L, serum PTH concentration 1 011 pg/ml and tumor diameter 3. 35 cm. These indicators can be helpful in the preoperative diagnosis of PC. Conclusions Patients with PC were younger than the patients with PA. Albumin-corrected serum calcium, serum PTH concentration, and tumor diameter can be helpful in preoperative diagnosis of PC. [ABSTRACT FROM AUTHOR]