一项临床病理研究表明,年龄、GH/IGF-1水平、肿瘤体积、T2低密度和肿瘤亚型(而非增殖和侵袭)都是肢端肥大症患者生长抑素类似物治疗生化反应的可靠预测指标

IF 1.6 4区 医学 Q4 CELL BIOLOGY
Elif Tutku Durmuş , Ayşegül Atmaca , Mehmet Kefeli , Sultan Çalışkan , Ozgur Mete , Kerim Aslan , Murat Fidan , Ramis Çolak , Buğra Durmuş
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引用次数: 4

摘要

目的探讨第一代生长抑素类似物(SSA)治疗对肢端肥大症患者的生化反应是否可以通过基线和术后激素浓度、肿瘤放射学和组织病理学特征来预测。方法对68例术后开始SSA治疗的肢端肥大症患者根据治疗反应(SSA反应者与无反应者)进行分类。根据患者的人口学特征、激素水平、磁共振成像(MRI)和组织病理学结果对其进行比较。采用单因素分析中显著的预测因素构建受试者工作特征(ROC)曲线,确定最佳临界值。结果ssa应答者年龄差异有统计学意义(p = 0.041)。诊断时较低的生长激素(p = 0.036)、术后第1周生长激素水平(p = 0.027)、基线生长激素、胰岛素样生长因子-1 (IGF-1)和IGF-1%正常上限(ULN) (p = 0.001、p = 0.006、p = 0.023)与生化反应相关。在ssa应答者中,t2低密度和肿瘤体积更常见(p = 0.018, p = 0.03)。与稀疏颗粒的生长营养瘤相比,致密颗粒的生长营养瘤和其他引起GH过量的PitNETs,包括乳腺生长营养瘤和混合生长营养瘤和乳营养瘤更容易对SSA治疗产生反应(p = 0.026, p = 0.03)。ROC曲线分析得到的截断值为:诊断时GH≤8.8 ng/mL,基线时GH≤2.69 ng/mL,基线时IGF-1≤461.5 ng/mL,基线时IGF-1% ULN≤180.4%,肿瘤体积≤1.11 cm3(均p <0.05)。两组在肿瘤侵袭性、增殖活性(每2mm2有丝分裂计数和Ki-67标记指数)和t2加权MRI定量分析方面均无差异。结论高龄、诊断时基线GH和IGF-1较低、肿瘤体积小、肿瘤颗粒密集亚型和T2低可能有助于预测肢端肥大症患者对SSA治疗的生化反应。所有患者在接受SSA治疗前都应高度重视这些变量的评估。在可能对SSA治疗产生耐药性的病例中,应更密切地监测治疗活动,如果反应不佳,应立即使用其他治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Age, GH/IGF-1 levels, tumor volume, T2 hypointensity, and tumor subtype rather than proliferation and invasion are all reliable predictors of biochemical response to somatostatin analogue therapy in patients with acromegaly: A clinicopathological study

Purpose

To determine whether biochemical responses to long-acting forms of first-generation somatostatin analogue (SSA) therapy in patients with acromegaly could be predicted from baseline and postoperative hormone concentrations, and tumor radiological and histopathological characteristics.

Methods

A total of 68 patients with acromegaly for whom postoperative SSA therapy was started were categorized according to their responses to treatment (SSA-responders vs. non-responders). The patients were compared based on their demographic characteristics, hormone levels, magnetic resonance imaging (MRI), and histopathological findings. Receiver-operating-characteristic (ROC) curves were constructed using the predictive factors that were significant in the univariate analysis to determinate the optimal cut-off values.

Results

The SSA-responders were significantly older (p = 0.041). Lower GH at diagnosis (p = 0.036), the postoperative 1st-week GH level (p = 0.027), baseline GH, insulin-like growth factor-1 (IGF-1) and IGF-1% upper limit of normal (ULN) (p = 0.001, p = 0.006, p = 0.023, respectively) were associated with biochemical response. T2-hypointensity and lower tumor volume were more common in the SSA-responders (p = 0.018, p = 0.03, respectively). Compared to sparsely granulated somatotroph tumors, densely granulated somatotroph tumors and other PitNETs causing GH excess including mammosomatotroph and mixed somatotroph and lactotroph tumors were more likely to respond to SSA therapy (p = 0.026, p = 0.03, respectively). The cut-off values generated by ROC curve analysis were GH at diagnosis of ≤8.8 ng/mL, GH at baseline of ≤2.69 ng/mL, IGF-1 at baseline ≤461.5 ng/mL, IGF-1% ULN at baseline ≤180.4%, and tumor volume of ≤1.11 cm3 (all p < 0.05). There were no differences between the groups in terms of tumor invasiveness, proliferative activity (mitotic count per 2 mm2 and Ki-67 labeling index) and quantitative analyses of T2-weighted MRI.

Conclusion

This study underscores that advanced age, low baseline GH and IGF-1 at diagnosis, low tumor volume, densely granulated tumor subtype, and T2 hypointensity may help predict biochemical response to SSA therapy in cases of acromegaly. These variables should be assessed with utmost attention for all patients prior to SSA treatment. In cases of possible resistance to SSA therapy, therapeutic activity should be monitored more closely and other therapies should be administered immediately in the event of poor response.

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来源期刊
Growth Hormone & Igf Research
Growth Hormone & Igf Research 医学-内分泌学与代谢
CiteScore
3.30
自引率
0.00%
发文量
38
审稿时长
57 days
期刊介绍: Growth Hormone & IGF Research is a forum for research on the regulation of growth and metabolism in humans, animals, tissues and cells. It publishes articles on all aspects of growth-promoting and growth-inhibiting hormones and factors, with particular emphasis on insulin-like growth factors (IGFs) and growth hormone. This reflects the increasing importance of growth hormone and IGFs in clinical medicine and in the treatment of diseases.
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