Non-functioning pituitary adenoma underwent surgery: A multicenter retrospective study over the last four decades (1977–2015)

Iglesias, Pedro; Arcano, Karina; Triviño, Vanessa; Garcia-Sancho, Paula; Díez, Juan J.; Cordido, Fernando; Villabona, Carles

doi:10.1016/j.ejim.2017.03.023

Cited by 21 publications

(17 citation statements)

References 35 publications

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“…7,13,19,29,30 Reports of progression rates after STR are much more variable due to heterogeneity of inclusion criteria, tumor characteristics, definitions of progression, and duration of follow-up. 15 In a series of 80 patients, Dallapiazza et al 3 reported a progression rate of 52% with a mean follow-up of 72 months. On the other hand, Seltzer et al 37 reported a progression rate of 8.3% in a group of 24 patients with a mean follow-up of 61 months.…”

Section: Fig 3 Predictors Of Recurrence/progression-free Survival In the Entire Cohort (A-c) And Predictors Of Progression-free Survival mentioning

confidence: 99%

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Gerges

Rumalla

Godil

et al. 2021

Journal of Neurosurgery

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OBJECTIVENonfunctioning pituitary adenomas are benign, slow-growing tumors. After gross-total resection (GTR) or subtotal resection (STR), tumors can recur or progress and may ultimately require additional intervention. A greater understanding of long-term recurrence and progression rates following complete or partial resection and the need for further intervention will help clinicians provide meaningful counsel for their patients and assist data-driven decision-making.METHODSThe authors retrospectively analyzed their institutional database for patients undergoing endoscopic endonasal surgery (EES) for nonfunctioning pituitary macroadenomas (2003–2014). Only patients with follow-up of at least 5 years after surgery were included. Tumor volumes were measured on pre- and postoperative MRI. Tumor recurrence was defined as the presence of a 0.1-cm3 tumor volume after GTR, and tumor progression was defined as a 25.0% increase in residual tumor after STR.RESULTSA total of 190 patients were included, with a mean age of 63.8 ± 13.2 years; 79 (41.6%) were female. The mean follow-up was 75.0 ± 18.0 months. GTR was achieved in 127 (66.8%) patients. In multivariate analysis, age (p = 0.04), preoperative tumor volume (p = 0.03), Knosp score (p < 0.001), and Ki-67 (p = 0.03) were significant predictors of STR. In patients with GTR, the probability of recurrence at 5 and 10 years was 3.9% and 4.7%, and the probability of requiring treatment for recurrence was 0.79% and 1.6%, respectively. In 63 patients who underwent STR, 6 (9.5%) received early postoperative radiation and did not experience progression, while the remaining 57 (90.5%) were observed. Of these, the probability of disease progression at 5 and 10 years was 21% and 24.5%, respectively, and the probability of requiring additional treatment for progression was 17.5% and 21%. Predictors of recurrence or progression in the entire group were Knosp score (p < 0.001) and elevated Ki-67 (p = 0.03). Significant predictors of progression after STR in those who did not receive early radiotherapy were cavernous sinus location (p < 0.05) and tumor size > 1.0 cm3 (p = 0.005).CONCLUSIONSFollowing GTR for nonfunctioning pituitary adenomas, the 10-year chance of recurrence is low and the need for treatment even lower. After STR, although upfront radiation therapy may prevent progression, even without radiotherapy, the need for intervention at 10 years is only approximately 20% and a period of observation may be warranted to prevent unnecessary prophylactic radiation therapy. Tumor volume > 1 cm3, Knosp score ≥ 3, and Ki-67 ≥ 3% may be useful metrics to prompt closer follow-up or justify early prophylactic radiation therapy.

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Section: Fig 3 Predictors Of Recurrence/progression-free Survival In the Entire Cohort (A-c) And Predictors Of Progression-free Survival mentioning

confidence: 99%

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Gerges

Rumalla

Godil

et al. 2021

Journal of Neurosurgery

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“…Remission rates of 76%-90% are expected in people, and, if there is no recurrence within 5 years, they are considered cured. [19][20][21][22][23][24][25][26][27] TS in dogs is currently performed successfully in the Netherlands, Japan, and the United States. [15][16][17][18] TS has been positively embraced in the Netherlands since 1997, with good long-term remission rates and low morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…TS is the first line of treatment in people in whom PDH is diagnosed. Remission rates of 76%‐90% are expected in people, and, if there is no recurrence within 5 years, they are considered cured . TS in dogs is currently performed successfully in the Netherlands, Japan, and the United States .…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal surgery: accuracy of an image‐guided neuronavigation system to approach the pituitary fossa (sella turcica)

et al. 2018

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“…PA can be functioning and non-functioning and its frequency depends on different factors, such as age at diagnosis and sex [5]. In young patients (second or third decade of life) and, mainly in women, the most frequent pituitary tumor is lactotrope adenoma (prolactinoma), usually less than 1 cm (microprolactinoma), whereas non-functioning PA (NFPA), usually ≥ 1 cm (macroadenoma), is more common in adults (around six decade of life), without sex predilection [6].…”

Section: Introductionmentioning

confidence: 99%

Giant Non-Functioning Pituitary Adenoma: Clinical Characteristics and Therapeutic Outcomes

Iglesias

Arcano

Triviño

et al. 2020

Exp Clin Endocrinol Diabetes

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Background Giant pituitary adenoma (≥4 cm) is a rare tumor whose clinical features and prognosis are not well known. Aim To evaluate the clinical characteristics and therapeutic outcomes of giant non-functioning PA (gNFPA). Patients and Methods A retrospective multicenter study of gNFPA patients diagnosed in a 12-year period was performed. In each patient, clinical data and therapeutic outcomes were registered. Results Forty patients (24 men, age 54.2 ± 16.2 years) were studied. The maximum tumor diameter [median (interquartile range)] was 4.6 cm (4.1–5.1). Women had larger tumors [4.8 cm (4.2–5.4) vs. 4.5 cm (4.0–4.9); p=0.048]. Hypopituitarism [partial (n=22, 55%) or complete (n=9, 22.5%)] at diagnosis was present in 77.5% of the patients. Visual field defects were found in 90.9%. The most used surgical technique was endoscopic endonasal transsphenoidal (EET) surgery (n=31, 77.5%). Radiotherapy was used in 11 (27.5%) patients (median dose 50.4 Gy, range 50–54). Thirty-seven patients were followed for 36 months (10–67 months). Although more than half of these patients showed tumor persistence (n=25, 67.6%), tumor size was significantly reduced [0.8 cm (0–2.5); p<0.001]. At last visit, 12 patients (32.4%) showed absence of tumor on MRI. Hypopituitarism rate was similar (75.0%), although with significant changes (p<0.001) in the distribution of the type of hypopituitarism. The absence of tumor at the last visit was positively associated with positive immunohistochemical staining for FSH (p=0.01) and LH (p=0.006) and negatively with female sex (p=0.011), cavernous sinus invasion (p=0.005) and the presence of Knosp grade 4 (p=0.013). Conclusion gNFPAs are more frequent in men but tumors are larger in women. Surgical treatment is followed by a complete tumor resection rate of approximately 30%. Positive immunostaining for gonadotropins is associated with tumor absence at last revision, while female sex and invasion of the cavernous sinuses with tumor persistence.

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Non-functioning pituitary adenoma underwent surgery: A multicenter retrospective study over the last four decades (1977–2015)

Cited by 21 publications

References 35 publications

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Transsphenoidal surgery: accuracy of an image‐guided neuronavigation system to approach the pituitary fossa (sella turcica)

Giant Non-Functioning Pituitary Adenoma: Clinical Characteristics and Therapeutic Outcomes

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