Related Experiment Video
Updated: May 10, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Validation and Limitations of the PANOMEN-3 Predictive Model for Tumor Recurrence and Progression in Pituitary Tumors
Marta Araujo-Castro1,2, Edelmiro Menéndez Torre3,4, Claudia-Lozano Aida3,4
1Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain.
Context:
It has been proposed that the PANOMEN-3 classification may be useful to guide the prognosis and therapy of patients with pituitary tumors (PTs). However, the model has not yet been validated to date in order to assess its usefulness in routine clinical practice.
Objective:
The aim of our study was to validate the classification proposed by the PANOMEN-3 group for the prediction of tumor recurrence/progression in PTs.
Methods:
Multicenter national case-control study of patients with PTs followed for at least 5 years. Kaplan-Meier curves were used to assess the time to tumor recurrence/progression. Univariate and multivariate Cox regression analyses were used to estimate the hazard ratio (HR) and prognostic capacity of the classification proposed by the PANOMEN-3 group.
Results:
A total of 1143 patients were included. Pituitary surgery was performed in 814 patients and the remaining 329 patients were followed with active surveillance or medical treatment. After a median follow-up of 8.8 years (5-29.8), 253 patients experienced tumor recurrence or biochemical/radiological progression and were classified as cases. The other 890 patients were classified as controls. The mean follow-up from PT diagnosis to recurrence was 7.2 ± 5.4 years. The diagnostic accuracy of the PANOMEN-3 model to predict recurrence/progression was 75.6% (95% CI 0.716-0.796). Residual tumor (HR 2.20, P < .001), a hereditary syndrome (HR 5.15, P = .026), and active secretory status (HR 1.80, P = .021) were the most important variables in this model. Recurrence/progression rate increased with increasing PANOMEN-3 grade (2.5% in grade 0; 10.3% in grade 1, 33.7% in grade 2, and 33.3% in grade 3; P < .001).
Conclusion:
The predictive model proposed by the PANOMEN-3 group may be useful to guide the prognosis and therapy of PTs in the Spanish population since it offers a good accuracy to predict tumoral/biochemical recurrence and/or progression in operated and nonoperated patients.
