无声垂体腺瘤复发和再治疗风险升高。

IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Pituitary Pub Date : 2024-04-01 Epub Date: 2024-02-12 DOI:10.1007/s11102-024-01382-3
Saksham Gupta, Samantha E Hoffman, Neel H Mehta, Blake Hauser, Marcelle Altshuler, Joshua D Bernstock, Timothy R Smith, Omar Arnaout, Edward R Laws
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引用次数: 0

摘要

目的:垂体腺瘤是垂体最常见的肿瘤,占所有颅内肿块的近 15%。这些肿瘤根据其激素表达和分泌模式被分为功能性和静息性两类。初步证据表明,某些功能性垂体腺瘤(FPA)亚型与沉默垂体腺瘤(SPA)亚型的临床结果存在差异:我们收集并分析了布里格姆妇女医院一位高容量神经外科医生在2007年至2018年期间接受SPA或FPA切除术的所有患者的病历。描述性统计和Mantel-Cox对数秩检验用于确定这些队列之间的结果差异,多变量逻辑回归用于确定SPA放射学复发的预测因素:我们的队列包括88例SPA和200例FPA。两个队列中的大多数患者都是女性(SPA占48.9%,FPA占63.5%)。SPA的中位直径大于FPA(2.1厘米对1.2厘米,P 结论:SPA的中位直径大于FPA:与其他腺瘤相比,接受SPA切除术的患者应通过更频繁的临床随访和诊断性影像学检查密切监测疾病复发情况,尤其是在STR患者和年轻患者中。有几名患者可在影像学复发后进行观察,应根据个体情况决定是否退缩。SPA的纵向临床随访,包括症状、内分泌功能和影像学评估,仍然至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Elevated risk of recurrence and retreatment for silent pituitary adenomas.

Purpose: Pituitary adenomas are the most common tumor of the pituitary gland and comprise nearly 15% of all intracranial masses. These tumors are stratified into functional or silent categories based on their pattern of hormone expression and secretion. Preliminary evidence supports differential clinical outcomes between some functional pituitary adenoma (FPA) subtypes and silent pituitary adenoma (SPA) subtypes.

Methods: We collected and analyzed the medical records of all patients undergoing resection of SPAs or FPAs from a single high-volume neurosurgeon between 2007 and 2018 at Brigham and Women's Hospital. Descriptive statistics and the Mantel-Cox log-rank test were used to identify differences in outcomes between these cohorts, and multivariate logistic regression was used to identify predictors of radiographic recurrence for SPAs.

Results: Our cohort included 88 SPAs and 200 FPAs. The majority of patients in both cohorts were female (48.9% of SPAs and 63.5% of FPAs). SPAs were larger in median diameter than FPAs (2.1 cm vs. 1.2 cm, p < 0.001). The most frequent subtypes of SPA were gonadotrophs (55.7%) and corticotrophs (30.7%). Gross total resection (GTR) was achieved in 70.1% of SPA resections and 86.0% of FPA resections (p < 0.001). SPAs had a higher likelihood of recurring (hazard ratio [HR] 3.2, 95% confidence interval [95%CI] 1.6-7.2) and a higher likelihood of requiring retreatment for recurrence (HR 2.5; 95%CI 1.0-6.1). Subset analyses revealed that recurrence and retreatment were more both likely for subtotally resected SPAs than subtotally resected FPAs, but this pattern was not observed in SPAs and FPAs after GTR. Among SPAs, recurrence was associated with STR (odds ratio [OR] 9.3; 95%CI 1.4-64.0) and younger age (OR 0.92 per year; 95%CI 0.88-0.98) in multivariable analysis. Of SPAs that recurred, 12 of 19 (63.2%) were retreated with repeat surgery (n = 11) or radiosurgery (n = 1), while the remainder were observed (n = 7).There were similar rates of recurrence across different SPA subtypes.

Conclusion: Patients undergoing resection of SPAs should be closely monitored for disease recurrence through more frequent clinical follow-up and diagnostic imaging than other adenomas, particularly among patients with STR and younger patients. Several patients can be observed after radiographic recurrence, and the decision to retreat should be individualized. Longitudinal clinical follow-up of SPAs, including an assessment of symptoms, endocrine function, and imaging remains critical.

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来源期刊
Pituitary
Pituitary 医学-内分泌学与代谢
CiteScore
7.10
自引率
7.90%
发文量
90
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.
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