Analysis of Related Factors of Tumor Recurrence or Progression After Transnasal Sphenoidal Surgical Treatment of Large and Giant Pituitary Adenomas and Establish a Nomogram to Predict Tumor Prognosis

Abstract

BackgroundPituitary adenoma (PA) is a benign neuroendocrine tumor caused by adenohypophysial cells, and accounts for 10%-20% of all primary intracranial tumors. The surgical outcomes and prognosis of giant pituitary adenomas measuring ≥3 cm in diameter differ significantly due to the influence of multiple factors such as tumor morphology, invasion site, pathological characteristics and so on. The aim of this study was to explore the risk factors related to the recurrence or progression of giant and large PAs after transnasal sphenoidal surgery, and develop a predictive model for tumor prognosis.MethodsThe clinical and follow-up data of 172 patients with large or giant PA who underwent sphenoidal surgery at the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2011 to December 2017 were retrospectively analyzed. The basic clinical information (age, gender, past medical history etc.), imaging features (tumor size, invasion characteristics, extent of resection etc.), and histopathological characteristics (pathological results, Ki-67, P53 etc.) were retrieved. SPSS 21.0 software was used for statistical analysis, and the R software was used to establish the predictive nomogram.ResultsSeventy out of the 172 examined cases (40.7%) had tumor recurrence or progression. The overall progress free survival (PFS) rates of the patients at 1, 3 and 5 years after surgery were 90.70%, 79.65% and 59.30% respectively. Log-rank test indicated that BMI (P < 0.001), Knosp classification (P < 0.001), extent of resection (P < 0.001), Ki-67 (P < 0.001), sphenoidal sinus invasion (P = 0.001), Hardy classification (P = 0.003) and smoking history (P = 0.018) were significantly associated with post-surgery recurrence or progression. Cox regression analysis further indicated that smoking history, BMI ≥25 kg/m2, Knosp classification grade 4, partial resection and ≥3% Ki-67 positive rate were independent risk factors of tumor recurrence or progression (P < 0.05). In addition, the nomogram and ROC curve based on the above results indicated significant clinical value.ConclusionThe postoperative recurrence or progression of large and giant PAs is related to multiple factors and a prognostic nomogram based on BMI (≥25 kg/m2), Knosp classification (grade 4), extent of resection (partial resection) and Ki-67 (≥3%) can predict the recurrence or progression of large and giant PAs after transnasal sphenoidal surgery.

Diabetic ketoacidosis and loss of consciousness as the first clinical presentations of apoplexy in a patient with recurrent pituitary adenoma: A Case Report study

“…The other highlightable aspect of this case is that multiple relapses occurred so close to each other. Obesity, high expression of Ki-67 (> 3%), partial resection, grade 4 of Knosp classification, and in adenomas with bony invasion, tumor volume, the extent of bone invasion, female sex, younger age are noted in the literature as risk factors for recurrent adenomas (17). While surgery is the first-line management option with excellent outcomes, non-operative management, including medical treatment and radiotherapy, are alternative treatment strategies in certain selected patients (18,19).…”

Analysis of neuroendoscopy for the treatment of macroadenomas and giant pituitary adenomas

“…Histopathological and immunohistochemical analyses were used to confirm the diagnosis of pituitary adenomas and assess multiple pituitary hormone levels. During data compilation, 429 patients met the radiological definitions of macroadenomas (1 ≤ D < 4 cm) and giant adenomas (≥4 cm) in addition to the criteria required for the neuroendoscopic transnasal surgical approach for butterfly macroadenoma and giant pituitary adenoma surgeries ( 11 ). Medical and nursing conditions remained consistent for all patients.…”

Pathological characteristics of reoperated regrowing clinically nonfunctioning pituitary tumor cases in comparison with initial surgical cases

“…However, evidence is still controversial owing to the technical difficulty of IHC and the lack of a sufficient number of reoperated NFPT cases (10)(11)(12)(13)(14)(15)(16). Previous studies emphasized that gross total resection (GTR) in the initial operation was essential to prevent regrowth (17,18). Thus, the better the surgical skills of the surgeon, the fewer regrowth occur.…”