Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study

Abstract

Context Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. It is important to identify patients in whom surgical cure is not attainable at an early stage, both to inform patients on expected treatment outcome and to select those who are more likely to need additional therapy. Objective To identify predictors for remission after TSS in acromegaly. Design Large multicenter study with retrospective data collection from three tertiary neurosurgical referral centers in the Netherlands. Methods We analyzed clinical data since 2000 from three cohorts (Groningen, Nijmegen and Rotterdam, total n=282). Multivariate regression models were used to identify predictors of early biochemical remission (12 weeks-1 year postoperatively) according to the 2010 consensus criteria, long-term remission (age- and sex normalized IGF-1 and the absence of postoperative treatment until last follow-up) and relative IGF-1 and GH reduction. Results A larger maximum tumor diameter (OR 0.91, 95% CI 0.87–0.96, p≤0.0001) was associated with a lower chance of early biochemical remission. A larger maximum tumor diameter (OR 0.93, 95% CI 0.89–0.97, p=0.0022) and a higher random GH concentration at diagnosis (OR 0.98, 95% CI 0.96–0.99, p=0.0053) were associated with a lower chance of long-term remission. Conclusion Maximum tumor diameter and random GH concentration at diagnosis are the best predictors for remission after TSS in acromegaly.

Machine learning-based clinical outcome prediction in surgery for acromegaly

“…Surgical outcome depends on many variables that are hard to account for-including surgical experience, skill, and caseload [2]-making their prediction difficult. ML methods can deduce a simple risk assessment model from relatively complex data [4,5]. For this reason, ML has been proven to aid in improved shared decision-making as well as enhanced patient care by modification of risk factors [7,27,28].…”

“…There are many variables that play into the likelihood of surgical success and endocrinological remission, such as age, Knosp grade, repeat surgeries, or even different somatostatin receptor subtypes [3][4][5]. The more factors that come into play, the harder it gets for clinicians to take them and their interactions into account.…”

Diagnosis and Treatment of Acromegaly: An Update

“…[46][47][48] In addition to surgical expertise and tumor size, tumor invasiveness and serum GH levels predict the likelihood of postoperative remission. [46][47][48][49][50] Immediate postoperative GH levels represent a strong predictor of longterm remission. 51 Patients with pituitary adenomas that extend into the cavernous sinuses, clivus, or dura are significantly less likely to achieve endocrine remission after transsphenoidal surgery and will generally require additional therapy.…”

“…51 Patients with pituitary adenomas that extend into the cavernous sinuses, clivus, or dura are significantly less likely to achieve endocrine remission after transsphenoidal surgery and will generally require additional therapy. 49,52 However, subtotal tumor resection (debulking) improves tumor response to SRL therapy. 53 Transsphenoidal surgery is generally effective in decompressing the optic chiasm, thereby improving vision in most patients who present with visual compromise as a result of mass effect exerted by a pituitary adenoma.…”

Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

“…Acromegaly is caused by an excess of GH, most commonly caused by a somatotroph PA, and is associated with significant metabolic changes that have a negative impact on quality of life (13). Uncontrolled acromegaly patients experience a lower life expectancy of 10-15 years and suffer from multimorbidity (14).…”