Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas
Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas
复制标题
DOI：
10.3171/jns/2008/108/4/0736
复制
发表时间：
2008-04-01
影响因子：
4.1
通讯作者：
Kunwar, Sandeep
中科院分区：
文献类型：
--
作者：
Chang, Edward F.;Zada, Gabriel;Kunwar, Sandeep
目的。尚不清楚非功能性垂体腺瘤（NFPA）手术后的长期结局。因此，辅助放射治疗的作用是有争议的，因为它与较高的肿瘤控制有关，但也具有已知的长期发病率。作者的目的是确定复发和总体生存的预测因素，并定义可能受益于放射疗法的患者亚组。作者对1975年至1995年接受手术的663例患者进行了回顾性队列分析，以治疗原发性NFPA。主要结果指标是手术后的疾病进展，该进展是由临床和/或成像标准以及全因死亡率定义的。在中位数为8。4年的临床随访中，治疗后有64例（9.7％）的复发，中位时间为5.6年。 5年，10年和15年的无复发概率分别为0.93、0.87和0.81。多元COX比例危险回归分析确定了以下预测因子与复发的增加有关：海绵窦入侵（危险比[HR] 3.6，95％置信区间[CI] 1.5-6.4; p <0.001）和无放射线疗法的下切除（STR） （HR 3.6，95％CI 1.4-14; P = 0.01）。使用事件时间估计来调整组之间的随访差异，发现放疗只能减少仅接受StR的患者的肿瘤复发（P <0.001，对数 - 对数测试），但不进行术语切除术（ GTR; p = 0.63，对数秩检验）。总生存期的中位随访时间为14。0年。 5，10，10年和20年的总生存率估计分别为0.91、0.81、0.69和0.55。在研究队列中，在与美国普通人群的年龄和性别调整后的比较中，接受放疗或Conconconconconconconions的患者中相对死亡率增加。海绵窦入侵是长期控制NFPA的重要预后变量。放射疗法会导致患有STR但不会影响复发率并可能增加GTR后死亡风险的患者进行长期肿瘤控制。鉴于与放射疗法相关的风险，其常规应用在接受NFPA的GTR的患者中没有作用。在所有患者中，都需要长期监测。
Object. Long-term outcomes following surgery for nonfunctional pituitary adenomas (NFPAs) are unclear. The role of adjuvant radiation therapy is therefore controversial because it is associated with higher tumor control but also carries known long-term morbidity. The authors' aim was to determine predictors of recurrence and overall survival and to define patient subgroups that may benefit from radiotherapy.Methods. The authors performed a retrospective cohort analysis of 663 patients who underwent surgery between 1975 and 1995 for treatment of primary NFPAs. The main outcome measures were disease progression after surgery, defined by clinical and/or imaging criteria, and all-cause mortality.Results. Over a median clinical follow-up of 8.4 years, there were 64 (9.7%) recurrences after treatment, with a median time to recurrence of 5.6 years. The 5-, 10-, and 15-year recurrence-free probabilities were 0.93, 0.87, and 0.81, respectively. Multivariate Cox proportional hazard regression analysis identified the following predictors as associated with increased recurrence: cavernous sinus invasion (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.5-6.4; p < 0.001) and subtotal resection (STR) without radiotherapy (HR 3.6, 95% CI 1.4-14; p = 0.01). Using time-to-event estimates to adjust for differences in follow-up between groups, radiotherapy was found to reduce tumor recurrence in only those patients who received an STR (p < 0.001, log-rank test) but not gross-total resection (GTR; p = 0.63, log-rank test). Median follow-up for overall survival was 14.0 years. The 5-, 10-, 15- and 20-year overall survival estimates were 0.91, 0.81, 0.69, and 0.55, respectively. Within the study cohort and in age- and sex-adjusted comparison with the general US population, increased relative mortality was observed in patients who underwent radiotherapy or STR.Conclusions. Cavernous sinus invasion is an important prognostic variable for long-term control of NFPAs. Radiotherapy results in long-term tumor control for patients who undergo STR but does not affect recurrence rates and may increase the risk of death after GTR. Given the risks associated with radiotherapy, there is no role for its routine application in patients who have undergone GTR of their NFPA. In all patients, long-term monitoring is required.