Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth
Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth
复制标题
DOI：
10.1046/j.1365-2265.2003.01784.x
复制
发表时间：
2003-06-01
影响因子：
3.2
通讯作者：
Stern, N
中科院分区：
文献类型：
--
作者：
Greenman, Y;Ouaknine, G;Stern, N
背景术后对临床无功能垂体腺瘤（NFPA）的术后管理提出了困难的挑战。肿瘤的存在或生长没有良好的血清标志物，医疗无效，放射疗法具有重大副作用的风险。本研究的目的是研究手术治疗的NFPA的自然病史和生物学行为，努力确定表明可以帮助临床决策过程的更具侵略性的特征。研究我们的NFPA机构进行的研究患者经历了统一的例行程序内分泌诊所的临床随访。磁共振成像（MRI）研究是在经苯甲酸手术后的3、6和12个月进行的，此后每年在头5年进行。随后，每2年或临床指示进行一次成像。从1992年开始，没有患者立即接受术后放射疗法。患者自1989年以来在我们机构上运营的一百22名患者（78m/45f），并且1年的随访最少，包括研究小组。测量肿瘤大小。和特征通过MRI使用Hardy's和Wilson的分类来确定。还记录了最大的肿瘤高度，并且该信息通常存储在计算机数据库中。均值（+/- SD）随访时间为51 +/- 31个月。 14例患者接受了术后放射治疗。其中五个观察到了随后的肿瘤生长，肿瘤大小减少了四个，五个肿瘤大小的变化却没有五个变化。一百八名患者未接受术后辐射。肿瘤肿大发生在78个中的41例中发生，在手术后有30例有和无残留肿瘤的患者中有6例（p = 0.0024）。手术前的海绵窦入侵存在[P = 0.02，优势比（OR）2.72；置信区间（CI）1.1-6.43]以及术后肿瘤残留物中的上延伸延伸程度（p = 0.0054，用于A期A或4.4; 95％CI 1.5-12.5; p = 0.012; C，或16.2; CI 1.8-144）是肿瘤增大的强有力的独立预测指标在控制肿瘤的患者中可能需要进行放射治疗的患者，并确认术后随访是低危患者的足够主要方法。
Background Postoperative management of clinically nonfunctioning pituitary adenomas (NFPA) presents difficult challenges. There are no good serum markers for presence or growth of the tumour, medical treatment is not effective and radiotherapy carries the risk of significant side-effects.Objective The purpose of this study was to investigate the natural history and biological behaviour of surgically treated NFPA, with a special effort to identify characteristics indicative of a more aggressive course that could assist in the clinical decision-making process.Study Design Patients operated on at our institution for NFPA undergo uniform routine clinical follow-up at the endocrine clinic. Magnetic resonance imaging (MRI) studies are performed 3, 6 and 12 months after transsphenoidal surgery and yearly thereafter for the first 5 years. Subsequently, imaging is performed once every 2 years or as clinically indicated. From 1992 onwards, no patient received immediate postoperative radiation therapy.Patients One hundred and twenty-two patients (78M/45F) operated on at our institution since 1989 and with a minimal follow-up of 1 year comprised the study group.Measurements Tumour size and characteristics were determined by MRI using a modification of Hardy's and Wilson's classifications. Maximal tumour height was also recorded and the information was routinely stored in a computerized database.Results Mean (+/-SD) follow-up was 51+/-31 months. Fourteen patients received postoperative radiation therapy. Subsequent tumour growth was observed in five of them, reduction in tumour size in four and no size changes in five. One hundred and eight patients did not receive postoperative radiation. Tumour enlargement occurred in 41 of 78 and in six of 30 patients with and without residual tumour after operation (P=0.0024). The presence of cavernous sinus invasion before surgery [P=0.02, odds ratio (OR) 2.72; confidence interval (CI) 1.1-6.43] and the extent of suprasellar extension in the postoperative tumour remnant (P=0.0054 for presence of stage A, OR 4.4; 95% CI 1.5-12.5; and P=0.012 for presence of stages B or C, OR 16.2; CI 1.8-144) were strong independent predictors of tumour enlargement.Conclusion Our data may ease the selection of patients in whom radiation therapy is likely to be necessary for tumour control, and confirms that close postoperative follow-up is an adequate primary approach in low-risk patients.