Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission

Araujo‐Castro, Marta; Pascual‐Corrales, Eider; Martínez-Vaello, Victoria; Saiz, G Baonza; Silva, J Quiñones de; Cancela, Alberto Acitores; Cano, A.; Berrocal, Víctor Rodríguez

doi:10.1007/s40618-020-01296-4

Cited by 22 publications

(14 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Higher SSA doses may be associated with tumor shrinkage and softening of their consistency, facilitating surgical removal. Moreover, presurgical GH levels and tumor size are well-known predictive factors of surgical remission [3].…”

Section: Discussionmentioning

confidence: 99%

The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

Araujo‐Castro¹,

Pascual‐Corrales²,

Pián³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose: To determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: Retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: Most patients, 83.3% (n=40), harboured macroadenomas and 31.3% (n=15) invasive pitu-itary adenomas. Fourteen patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60-120] and 20 [range 20-30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and un-treatred patients (P>0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanre-otide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR=4.64, P=0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR=0.65, P=0.570)), independently of the doses and the duration of SSA treatment (P>0.05). Conclusions: The dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

show abstract

Section: Discussionmentioning

confidence: 99%

The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

Araujo‐Castro¹,

Pascual‐Corrales²,

Pián³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…In these group of patients, remission rate is of 60-70% and 10-30%, respectively, in hands of experienced neurosurgeons [2,4] There are several studies that have been focused on predictive factors of surgical remission in acromegaly [5][2] [6]. Classical factors are tumor size [7], GH levels [5][2], Knosp grade [6] [2], and age [2]. Moreover, tumor consistency was reported to be an important predictive factor since hard consistency could impede transsphenoidal resection, especially in macroadenomas [8].…”

Section: Main Text Introductionmentioning

confidence: 86%

“…Exclusion criteria were: i) Previous pituitary surgery , treatment with dopamine agonists and/or radiotherapy (n=3) and ii) not available information of clinical, hormonal, radiological or histological tumor characteristics, iii) operated by other neurosurgeons (n=4) and iv) tumor size <10mm (n=8). Patients with microadenomas were excluded in our study since one of our purposes was to evaluate the possible relation between SRL pre-treatment and surgical remission, and it is known that surgical cure is achieved in nearly 100% of GH-secreting pituitary microadenomas [2]. A total of 40 patients were included.…”

Section: Patientsmentioning

confidence: 99%

“…However, although surgical remission is achieved in up to 100% of microadenomas in reference centers [2], there is a high risk of not achieving cure in macroadenomas, which account for up to 77% [3], and in invasive PAs. In these group of patients, remission rate is of 60-70% and 10-30%, respectively, in hands of experienced neurosurgeons [2,4] There are several studies that have been focused on predictive factors of surgical remission in acromegaly [5][2] [6]. Classical factors are tumor size [7], GH levels [5][2], Knosp grade [6] [2], and age [2].…”

Section: Main Text Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Presurgical somatostatin receptor ligand treatment does not affect tumor consistency in GH-secreting pituitary macroadenomas

Araujo-Castro

Pián

Ruz-Caracuel

et al. 2021

Endocrine Connections

View full text Add to dashboard Cite

Purpose: To evaluate whether pre-surgical treatment using long-acting somatostatin receptor ligands (SRL) may change pituitary tumor consistency and improve surgical outcome in GH-secreting pituitary macroadenomas. Methods: Retrospective study of 40 patients with GH-secreting pituitary macroadenomas operated for the first time by endoscopic transsphenoidal approach. Tumor consistency was evaluated intraoperatively and then correlated with histopathological fibrosis parameters and surgical outcomes. Surgical remission was reported based on the 2010 criteria. Results: The mean tumor size of GH-secreting macroadenomas was of 16.9±8.2mm and 25 were invasive pituitary adenomas (PAs). Presurgical treatment with long-acting SRL was performed in 17 patients (11 lanreotide, 6 octreotide). The cure rate was higher in those patients pre-treated with monthly doses ≥30mg of octreotide or ≥90mg of lanreotide than in those treated with lower doses or untreated (8/11 vs 11/29, P=0.049). However, although the proportion of soft tumors increased as higher doses of SRL were considered in the pre-treated group, no statistical significance was reached, even when the highest approved monthly doses were used (6/6 vs 23/34, P=0.102). Moreover, we found that the remission rate was similar between fibrous and soft tumors (P=0.873) and also of surgical complications (P=0.859), despite of the higher prevalence of Knosp>2 (P=0.035) and very large PA (P=0.025) in fibrous tumors than in soft tumors. Conclusions: Although presurgical treatment with high doses of SRL was associated with a 2.2-fold greater chance of surgical remission, this benefit was not related with changes in tumor consistency induced by the presurgical treatment.

show abstract

“…However, primary or pre-surgical treatment with somatostatin analogues (SSAs) in patients who are not expected to be cured by surgery could be considered [3,4]. The surgical remission rate is stabilized around 60-75% in large series from expert centres, but the overall remission rates decreased to 40-60% for macroadenomas and even 10-20% for invasive macroadenomas [5].…”

Section: Introductionmentioning

confidence: 99%

The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

show abstract

Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission

Cited by 22 publications

References 42 publications

The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

Presurgical somatostatin receptor ligand treatment does not affect tumor consistency in GH-secreting pituitary macroadenomas

The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Contact Info

Product

Resources

About