Predictors of Durable Remission After Successful Surgery for Cushing Disease: Results From the Multicenter RAPID...

Area of Science:

• Endocrinology
• Neurosurgery
• Oncology

Background:

• Cushing disease (CD) significantly impacts mortality and quality of life, with limited long-term remission rates.
• Identifying predictors for CD recurrence after transsphenoidal surgery is crucial for patient management.
• Previous studies on recurrence predictors have been limited by single-center data and inconsistent findings.

Purpose of the Study:

• To evaluate the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database.
• To identify robust, nonhormonal predictors of CD recurrence after transsphenoidal surgery.
• To improve patient counseling and prognostication for Cushing disease.

Main Methods:

• Analysis of a multicenter cohort of 383 patients with treated CD from 2011 to 2023.
• Assessment of perioperative and long-term characteristics of patients with and without recurrence.
• Utilized univariable and multivariable analyses, including hazard prediction models.

Main Results:

• Of 383 patients achieving initial remission, 24.8% experienced recurrence (median time 9.99 years).
• Recurrence was associated with longer hospital stays, larger tumor volumes, and prior failed treatments.
• Younger age (OR=0.95) and lower Knosp grades (grade 0: OR=0.09; grades 0-2: OR=0.27) were protective against recurrence.

Conclusions:

• Tumor size/invasion and patient age are the strongest predictors of Cushing disease recurrence.
• Lower Knosp grades (indicating less tumor invasion) are associated with a reduced risk of recurrence.
• Long-term follow-up and early intervention for small tumors may enhance outcomes in CD patients.