Factors Influencing Hormone Remission in Growth Hormone-Secreting Pituitary Neuroendocrine Tumors With Residual Tumor: A Retrospective Cohort Study

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-08-25 DOI:10.1111/cns.70574

Yangyang Wang, Li Ma, Chuanbao Zhang, Shunchang Ma, Guijun Jia, Wang Jia, Xiudong Guan

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Abstract

Background

Growth hormone-secreting pituitary neuroendocrine tumors (GH-secreting PitNETs) pose significant health risks due to hormone-related complications. Despite transsphenoidal surgical resection being the primary treatment, complete removal is often infeasible due to invasive growth patterns, leading to postoperative tumor residuals and uncertain hormone remission outcomes.

Methods

This retrospective study included 458 patients with GH-secreting PitNETs who underwent surgery at Beijing Tiantan Hospital. Data on preoperative hormone levels, MRI scans, and histopathological features were analyzed. Tumor segmentation, intratumor heterogeneity (ITH) scores, and subcluster clustering based on MRI data were computed using radiomic features, while multivariate analyses determined factors influencing hormone remission. Single-cell data from four GH-type pituitary adenomas were collected from public databases to explore ITH in GH1 gene expression.

Results

Postoperative hormone remission was achieved in 61 of 144 patients (42.4%) with residual tumors. Univariate analysis demonstrated that in cases with tumor residuals, preoperative hormone levels, tumor resection rates, residual tumor volume, tumor residual location, residual-tumor proximity to the internal carotid artery, and MRI-based tumor heterogeneity were associated with hormone remission. Among these factors, preoperative hormone levels (10–30 ng/mL vs. ≤ 10 ng/mL: OR: 0.48, 95% CI 0.20–1.19, p = 0.115; > 30 ng/mL vs. ≤ 10 ng/mL: OR: 0.13, 95% CI: 0.04–0.36, p < 0.001), tumor resection rate (OR: 18.29, 95% CI: 2.08–160.97, p = 0.009), and tumor heterogeneity as measured by the ITH score (OR: 1.06, 95% CI: 1.00–1.12, p = 0.042) were independent predictors of hormone remission in cases with residual tumors. Moreover, single-cell data showing highly variable GH1 expression within the same patient reveal ITH in hormone expression.

Conclusion

Preoperative GH levels, tumor resection rates, and ITH scores independently predict hormone remission in GH-secreting PitNETs with residuals. This will provide intraoperative decision-making guidance on how to achieve the maximum possible hormone remission with residual tumors when complete tumor resection is not feasible.

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影响生长激素分泌垂体神经内分泌肿瘤残留肿瘤激素缓解的因素：一项回顾性队列研究

生长激素分泌垂体神经内分泌肿瘤（GH-secreting PitNETs）由于激素相关并发症而造成重大的健康风险。尽管经蝶窦手术切除是主要的治疗方法，但由于侵袭性生长模式，导致术后肿瘤残留和激素缓解结果不确定，完全切除往往是不可行的。方法回顾性分析在北京天坛医院行手术治疗的458例gh分泌型PitNETs患者。分析术前激素水平、MRI扫描和组织病理学特征的数据。利用放射学特征计算肿瘤分割、肿瘤内异质性（ITH）评分和基于MRI数据的亚簇聚类，同时通过多变量分析确定影响激素缓解的因素。从公共数据库中收集4例gh型垂体腺瘤的单细胞数据，探讨ITH对GH1基因表达的影响。结果144例残留肿瘤患者中61例（42.4%）术后激素缓解。单因素分析表明，在存在肿瘤残留的病例中，术前激素水平、肿瘤切除率、残留肿瘤体积、残留肿瘤位置、残留肿瘤与颈内动脉的接近程度以及基于mri的肿瘤异质性与激素缓解有关。在这些因素中，术前激素水平（10 - 30 ng/mL vs.≤10 ng/mL: OR: 0.48, 95% CI 0.20-1.19, p = 0.115; 30 ng/mL vs.≤10 ng/mL: OR: 0.13, 95% CI: 0.04-0.36, p = 0.001）、肿瘤切除率（OR: 18.29, 95% CI: 2.08-160.97, p = 0.009）和ITH评分测量的肿瘤异质性（OR: 1.06, 95% CI: 1.00-1.12, p = 0.042）是残留肿瘤患者激素缓解的独立预测因子。此外，单细胞数据显示，同一患者体内GH1表达高度可变，这表明激素表达存在ITH。结论术前GH水平、肿瘤切除率和ITH评分独立预测GH分泌PitNETs的激素缓解和残差。这将为在无法完全切除肿瘤的情况下，如何在残余肿瘤的情况下实现最大可能的激素缓解提供术中决策指导。

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

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.