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Updated: Jun 25, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Prognostic value of immediate and short-term postoperative biochemical markers for long-term remission in acromegaly:
Tzu-Hua Chen1, Shyang-Rong Shih2, Huan-Chih Wang1
1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City 100, Taiwan.
Purpose:
This study aimed to identify clinical and biochemical predictors of short- and long-term surgical outcomes in patients with acromegaly, with a particular focus on postoperative risk stratification using a consensus-based IGF-1 normalization framework.
Methods:
This retrospective, single-center cohort study collected data of consecutive patients with acromegaly who underwent transsphenoidal surgery between 2000 and 2022. In accordance with the latest consensus, short-term (3-6 months) and long-term (>6 months) outcomes were primarily stratified by IGF-1 status and the presence of residual tumor. Multivariable regression and Cox proportional hazards models were used to identify predictors of outcomes and disease-free survival (DFS).
Results:
Poor short-term outcomes were associated with higher Knosp grade (OR = 9.52, 95%CI: 2.02-44.92), larger tumor size (OR = 5.20, 95%CI: 2.36-11.48), and elevated baseline IGF-1 (OR = 1.003, 95%CI: 1.001-1.005). Long-term recurrence was independently predicted by higher baseline IGF-1 (OR = 1.01, 95%CI: 1.002-1.008), elevated postoperative GH (OR = 1.49, 95%CI: 1.01-2.21), and elevated postoperative IGF-1 (OR = 1.02, 95%CI: 1.01-1.04). Patients with early biochemical persistence without residual tumor (Group B) had a significantly increased risk of long-term persistence compared to those with early remission (adjusted OR = 5.85, 95%CI: 1.77-19.31). Higher baseline and postoperative IGF-1 levels were also associated with shorter DFS.
Conclusions:
Pre- and postoperative IGF-1 levels showed consistent prognostic value for long-term outcomes, supporting the clinical utility of an IGF-1-centric stratification strategy. Notably, while preoperative GH levels show limited prognostic value, postoperative GH elevation remained associated with long-term recurrence. This framework facilitates individualized follow-up and long-term management of acromegaly.