Refractory pituitary adenoma: a novel classification for pituitary tumors.
Refractory pituitary adenoma: a novel classification for pituitary tumors.
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难治性垂体腺瘤：垂体肿瘤的新分类。
DOI：
10.18632/oncotarget.13274
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发表时间：
2016-12-13
期刊：
影响因子：
--
通讯作者：
Wang R
中科院分区：
文献类型：
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作者：
Dai C;Feng M;Liu X;Ma S;Sun B;Bao X;Yao Y;Deng K;Wang Y;Xing B;Lian W;Zhong D;Ma W;Wang R
根据病理学特征、放射学表现和临床表现，垂体腺瘤分为典型或非典型、侵袭性或非侵袭性、侵袭性或非侵袭性。只有脑垂体肿瘤伴有脑脊髓和/或全身转移才被认为是恶性肿瘤。然而，一些高Ki-67指数的垂体腺瘤表现出侵略性的行为，如快速增长，早期和频繁复发，并抵抗常规治疗，即使在没有转移。需要新的术语来定义这些肿瘤。在这里，我们建议使用术语“难治性垂体腺瘤”来定义恶性垂体瘤，其表现为1）高Ki-67指数和快速生长，2）早期和高频率复发，3）对常规治疗和/或替莫唑胺（TMZ）挽救治疗的抵抗，4）预后不良，5）缺乏脑脊液或全身转移。为了说明这种难治性垂体腺瘤分类的实用性和在这些患者中管理疾病的困难，我们检查了12例临床病例。正确识别难治性垂体腺瘤对改善患者预后至关重要。早期识别可能会鼓励早期使用积极的治疗策略，以防止或延迟复发。
Pituitary adenomas are classified as typical or atypical, invasive or noninvasive, and aggressive or nonaggressive based on pathological features, radiological findings, and clinical behavior. Only pituitary tumors with cerebrospinal and/or systemic metastasis are considered malignant carcinomas. However, some pituitary adenomas with high Ki-67 indexes exhibit aggressive behaviors, such as rapid growth, early and frequent recurrence, and resistance to conventional treatment, even in the absence of metastasis. Novel terminology is needed to define these tumors. Here, we propose the use of the term “refractory pituitary adenoma” to define malignant pituitary tumors exhibiting 1) a high Ki-67 index and rapid growth, 2) early and high frequency of recurrence, 3) resistance to conventional treatments and/or salvage treatment with temozolomide (TMZ), 4) poor prognosis, 5) and a lack of cerebrospinal or systemic metastases. To illustrate the utility of this refractory pituitary adenoma classification and the difficulty in managing disease in these patients, we examined twelve clinical cases. Correctly identifying refractory pituitary adenomas is crucial for improving patient prognoses. Early identification might encourage the early use of aggressive therapeutic strategies to prevent or delay recurrence.