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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
19.3K
A practical algorithm to predict postsurgical recurrence and progression of pituitary neuroendocrine tumours
Federica Guaraldi1,2, Matteo Zoli1,2, Alberto Righi3
1IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Clinical Endocrinology
|April 20, 2020
Summary
Aggressive pituitary neuroendocrine tumors (PitNETs) pose treatment challenges. This study identified key prognostic factors like tumor grade, invasion, and proliferation markers to predict postsurgical outcomes and recurrence risk in PitNET patients.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Pituitary neuroendocrine tumors (PitNETs) can exhibit aggressive behavior, leading to local invasion, postsurgical recurrence, and treatment resistance, causing significant patient morbidity.
- Identifying prognostic factors is crucial for predicting postsurgical outcomes and managing PitNETs effectively.
Purpose of the Study:
- To identify prognostic factors for postsurgical outcomes in patients with PitNETs.
- To utilize data-driven classification for stratifying patients based on recurrence and progression risk.
Main Methods:
- A retrospective observational study involving 1066 patients with PitNETs treated via endoscopic endonasal surgery.
- Clinicopathological and radiological data were analyzed using classification tree analysis (CTA) and Kaplan-Meier curves.
- Evaluated factors included histological subtype, invasion, mitosis, Ki-67, p53 expression, Trouillas' grading, and extent of tumor resection.
Main Results:
- Disease recurrence/progression occurred in 10.9% of patients, with 79.4% achieving cure.
- Classification tree analysis identified 5 distinct patient subgroups with varying recurrence/progression risks.
- Risk factors for recurrence/progression included higher Trouillas' grade (Grade 2), increased mitoses (>2/10 HPF), elevated Ki-67 (≥3%), p53 expression, tumor invasion, and ACTH-subtype.
Conclusions:
- The combined evaluation of Trouillas' grading, proliferation indexes (Ki-67, mitoses), and immunohistochemistry (p53) shows promise for predicting surgical outcomes in PitNETs.
- These markers can aid in stratifying patients and tailoring treatment strategies to improve postsurgical management and reduce recurrence.
