Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

Abstract

Context: Adequate postoperative management of nonfunctioning pituitary macroadenomas (NFMAs) remains a challenge for the clinician. Objective: To identify predictive factors of NFMA relapse after initial surgery. Patients and methods: This retrospective study included 142 patients operated for an NFMA in two academic centers (CHU Bicêtre in France and UCL St Luc in Belgium). The rate of tumor relapse, defined as recurrence after total surgical resection or regrowth of a surgical remnant, as well as predictive factors was analyzed. Results: During a mean follow-up of 6.9 years, 10 out of 42 patients (24%) who had complete macroscopic resection of their tumor had recurrence, and 47 out of 100 patients (47%) with a surgical remnant experienced regrowth. The overall relapse rates were 25, 43, and 61% at 5, 10, and 15 years respectively. Invasion of the cavernous sinus, absence of immediate radiotherapy after the first neurosurgery, and immunohistochemical features of the tumor (mainly positive immunostaining for several hormones or for hormones other than gonadotropins) were independent risk factors for tumor relapse. Incomplete excision was only associated with relapse when invasion was withdrawn from the analysis, suggesting that these two factors are closely linked. Conclusion: NFMAs frequently recur/regrow after initial surgery, particularly when tumor is invasive, precluding complete removal. Immunohistochemical features such as positive immunostaining for several hormones or for hormones other than gonadotropins could help to predict undesirable outcomes.

Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients

“…Noticeably, recurrence of hyperprolactinemia seems to occur at a constant rate over time and half of the relapsing patients did so 3 years or more after surgery. Thus, the longer the follow up, the higher the relapse rate, an observation which is similar to what has been reported for patients with nonfunctioning pituitary adenomas (33,34). Our findings thus emphasize the necessity to follow these patients for many years after apparent surgical remission.…”

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

“…While transsphenoidal surgery is the primary treatment option in most patients with NFA, the surgical outcomes may significantly depend on tumor size, 55 the presence of invasive growth into adjacent structures, 16 histological characteristics, 15,20,42,55,61 and the experience of the surgeon. 21 As virtually all symptomatic NFA are macroadenomas with frequent tumor growth exceeding the narrow confines of the sella, a considerable number of these tumors may not be completely resectable.…”

Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists

“…Nevertheless, as these tumors are mostly invasive macroadenomas, a complete resection is challenging. Most patients harbor residual postoperative tumor tissue, which, if left untreated, is associated with progression rates of over 40% in [5][6][7][8][9][10] years (3,4,5). Radiation therapy may be effective in preventing residual tumor growth (6), but is associated with a high rate of complications, thus limiting routine use (7,8).…”