Predictors of surgical outcome and early criteria of remission in acromegaly
Predictors of surgical outcome and early criteria of remission in acromegaly
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DOI：
10.1007/s12020-018-1590-8
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发表时间：
2018-06-01
期刊：
影响因子：
3.7
通讯作者：
Kasuki, Leandro
中科院分区：
文献类型：
--
作者：
Antunes, Ximene;Ventura, Nina;Kasuki, Leandro
经蝶窦手术（TSS）是肢端肥大症治疗的基石，但没有强有力的手术结果预测因素，并且只能在手术后三个月才能定义缓解。要分析生化、人口统计学、放射学、和免疫组化特征是手术缓解的预测因子，并研究术后即刻GH和IGF-1是否I水平可以帮助更早地确定缓解。对2013-2016年间提交TSS的连续性肢端肥大症患者进行了评估。缓解标准定义为术后3个月IGF-I正常且GH < 1 mcg/L。年龄、性别、GH和IGF-I水平、肿瘤体积、海绵窦浸润、T2加权信号、Ki-67和肉芽组织类型与缓解状态相关。GH和IGF-I水平在术后24，48小时，和一周的早期缓解标准进行了评估。69例患者（84%的大腺瘤），手术缓解率为45%。治愈和未治愈患者之间在年龄、性别、术前GH或IGF-I水平、肿瘤体积、T2加权信号、Ki-67和肿瘤粒度方面没有观察到差异。36例非侵袭性肿瘤中有20例（56%）缓解，16例侵袭性肿瘤中有3例（19%）缓解（p = 0.017）。术后48 h GH < 1.57 mcg/L预测缓解的敏感性为93%，特异性为86%，术后1周IGF-I < 231% ULNR预测缓解的敏感性为86%，特异性为93%，海绵窦侵犯是术前唯一预测缓解的指标。术后48 h GH和术后1周IGF-I可作为未治愈患者的早期诊断指标。
Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery.To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier.Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH < 1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission.Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH < 1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity.Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.