Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy
Tumor Recurrence or Regrowth in Adults With Nonfunctioning Pituitary Adenomas Using GH Replacement Therapy
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DOI：
10.1210/jc.2015-1764
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发表时间：
2015-08-01
影响因子：
5.8
通讯作者：
Drent, M. L.
中科院分区：
文献类型：
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作者：
van Varsseveld, N. C.;van Bunderen, C. C.;Drent, M. L.
背景：生长激素替代疗法 (GH-RT) 是一种广泛接受的治疗生长激素缺乏成人无功能性垂体腺瘤 (NFPA) 的方法。然而，由于 GH-RT 对肿瘤生长的潜在刺激作用，人们对 GH-RT 的安全性提出了一些担忧。 目的：本研究的目的是使用 GH-RT 评估 NFPA 患者的肿瘤进展。设计、环境和患者：根据荷兰国家成人生长激素治疗登记处（一项针对严重 GH 缺乏成人的全国性监测研究（1998-2009 年）），选择了所有 GH-RT ≥ 30 天的 NFPA 患者（n = 783）。数据从成年期 GH-RT 开始时（基线）进行回顾性收集。主要结果指标：肿瘤进展，包括基线完全缓解后的肿瘤复发和残留肿瘤的再生长。结果：12.1% 的患者在中位（范围）时间 2.2（0.1-14.9）年后出现肿瘤进展。与张力放射治疗相比，既往放射治疗降低了肿瘤进展风险（风险比 = 0.16；95% 置信区间，0.09-0.26）。对 577 名具有可用基线影像数据的患者进行的分析表明，与无残留肿瘤相比，基线时残留肿瘤会增加肿瘤进展风险（风险比 = 4.5；95% 置信区间为 2.4-8.2）。 结论：这项大型研究的结果与文献报道的结果一致，并提供了进一步的证据，表明 GH-RT 似乎不会增加 NFPA 患者的肿瘤进展风险。虽然只有长期随机对照试验才能得出确切的结论，但我们的数据支持目前的观点，即 GH-RT 对于 NFPA 患者是安全的。
Context: GH replacement therapy (GH-RT) is a widely accepted treatment in GH-deficient adults with nonfunctioning pituitary adenoma (NFPAs). However, some concerns have been raised about the safety of GH-RT because of its potentially stimulating effect on tumor growth.Objective: The aim of this study was to evaluate tumor progression in NFPA patients using GH-RT.Design, Setting, and Patients: From the Dutch National Registry of Growth Hormone Treatment in Adults, a nationwide surveillance study in severely GH-deficient adults (1998-2009), all NFPA patients with >= 30 days of GH-RT were selected (n = 783). Data were retrospectively collected from the start of GH-RT in adulthood (baseline).Main Outcome Measure: Tumor progression, including tumor recurrence after complete remission at baseline and regrowth of residual tumor.Results: Tumor progression developed in 12.1% of the patients after a median (range) time of 2.2 (0.1-14.9) years. Prior radiotherapy decreased tumor progression risk compared tonoradiotherapy (hazard ratio = 0.16; 95% confidence interval, 0.09-0.26). Analysis in 577 patients with available baseline imaging data showed that residual tumor at baseline increased tumor progression risk compared to no residual tumor (hazard ratio = 4.5; 95% confidence interval, 2.4-8.2).Conclusions: The findings in this large study were in line with those reported in literature and provide further evidence that GH-RT does not appear to increase tumor progression risk in NFPA patients. Although only long-term randomized controlled trials will be able to draw firm conclusions, our data support the current view that GH-RT is safe in NFPA patients.