Outcome of non-functioning ACTH pituitary tumors: silent does not mean indolent.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2024-10-01 Epub Date: 2024-07-12 DOI:10.1007/s11102-024-01428-6

Nicolas Sahakian, Lise Goetz, Romain Appay, Thomas Graillon, Isabelle Raingeard, Cécilia Piazzola, Jean Regis, Frédéric Castinetti, Thierry Brue, Henry Dufour, Thomas Cuny

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引用次数: 0

Abstract

Introduction: Silent corticotroph tumors (siACTH) represent a rare entity of pituitary tumors (PT), usually more aggressive than other PT. Few predictor factors of recurrence in the post-operative period have been proposed until now. This study aimed (1) to evaluate the clinical outcome of siACTH after surgery according to a five-tiered clinicopathological classification (2) to compare siACTH characteristics to ACTH-secreting macroadenomas (macroCD), and silent gonadotropinomas (siLH/FSH).

Patients and methods: Between 2008 and 2022, 29 siACTH out of 865 PT cases operated in one tertiary center were included. Clinical, paraclinical, histological, and surgical data were collected and compared to 25 macroCD and 143 siLH/FSH cases, respectively. The tumor grading was established according to both invasion (no = 1; yes = 2) and proliferation (no = a; yes = b). Progression-free survival was estimated using Kaplan-Meier method and log-rank test.

Results: We identified 15 (51.7%) grade 1a, 11 (37.9%) grade 2a and 3 (10.3%) grade 2b siACTH with a trend for a 7-fold-time higher risk of progression/recurrence in grade 2b as compared to 1a (p = 0.06). The repartition of tumor grades was similar between the three subgroups, however a 5.7-fold-higher risk of progression was observed in grade 1a siACTH than in grade 1a siLH/FSH (p = 0.02). Compared to siLH/FSH, higher ACTH levels may help to preoperatively identify siACTH.

Conclusion: The five-tiered clinicopathological classification contribute to predict the risk of recurrence of operated siACTH tumors. Noteworthy, non-invasive and non-proliferative siACTH exhibit a less favorable outcomes than their siLH/FSH counterparts, which should prompt for a personalized follow up.

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无功能性促肾上腺皮质激素垂体瘤的预后：无声并不意味着无症状。

简介沉默性皮质营养瘤（siACTH）是垂体瘤（PT）中的一种罕见肿瘤，通常比其他垂体瘤更具侵袭性。迄今为止，很少有人提出术后复发的预测因素。本研究旨在：（1）根据临床病理学五级分类评估siACTH术后的临床结局；（2）比较siACTH与分泌促肾上腺皮质激素的大腺瘤（macroCD）和沉默的促性腺激素瘤（siLH/FSH）的特征：方法： 2008年至2022年期间，在一家三级医疗中心进行手术的865例PT病例中有29例siACTH。收集了临床、辅助临床、组织学和手术数据，并分别与25例macroCD和143例siLH/FSH病例进行比较。肿瘤分级根据浸润（无=1；有=2）和增殖（无=a；有=b）确定。采用 Kaplan-Meier 法和对数秩检验估算无进展生存期：我们发现了15例（51.7%）1a级、11例（37.9%）2a级和3例（10.3%）2b级siACTH，与1a级相比，2b级肿瘤的进展/复发风险有增加7倍的趋势（p = 0.06）。三个亚组的肿瘤分级相似，但1a级siACTH的进展风险比1a级siLH/FSH高5.7倍（p = 0.02）。与 siLH/FSH 相比，更高的 ACTH 水平有助于术前识别 siACTH：结论：临床病理学五级分类有助于预测手术后 siACTH 肿瘤的复发风险。值得注意的是，非浸润性和非增生性 siACTH 的预后不如 siLH/FSH 同类肿瘤，因此应进行个性化随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.