A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up
A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up
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DOI：
10.1007/s00401-013-1084-y
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发表时间：
2013-07-01
影响因子：
12.7
通讯作者：
Raverot, Gerald
中科院分区：
文献类型：
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作者：
Trouillas, Jacqueline;Roy, Pascal;Raverot, Gerald
垂体腺瘤目前分类的组织学，免疫细胞化学和许多超微结构特征缺乏明确的预后相关性。我们研究了一种新的临床病理学分类的预后价值，该分类基于浸润和增殖。这项回顾性多中心病例对照研究包括410例垂体瘤手术患者，并进行了长期随访。应用垂体磁共振成像、免疫细胞化学、细胞周期标志物诊断海绵窦或蝶窦受侵（Ki-67，有丝分裂）和p53，肿瘤根据大小分类（微观、宏观和巨型），类型（PRL、GH、FSH/LH、ACTH和TSH）和等级（1a级：非侵入性，1b级：非侵入性和增殖性，2a级：侵入性，2b级：侵入性和增殖性，3级：转移性）。通过两项评估疾病或无复发/无进展状态的多变量分析，评价8年随访时患者状态与年龄、性别和分类之间的相关性。术后8年，195例患者无疾病（对照组），215例患者无疾病（病例组）。在125例病例中，肿瘤复发或进展。对无疾病和无复发/无进展状态的分析揭示了年龄、肿瘤类型和所有肿瘤类型和每种肿瘤类型的分级的显著预后价值（p < 0.001; p < 0.05）。与非侵袭性肿瘤（1a级）相比，侵袭性和增殖性肿瘤（2b级）的预后较差，肿瘤持续存在或进展的概率分别增加25倍或12倍。这种新的，易于使用的垂体内分泌肿瘤的临床病理学分类已经证明了其预后价值，通过强有力地预测术后完全缓解或肿瘤进展的可能性，因此可以帮助临床医生选择最佳的术后治疗。
Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.