Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Nonfunctioning pituitary adenomas are benign, slow-growing tumors. After gross-total resection (GTR) or subtotal resection (STR), tumors can recur or progress and may ultimately require additional intervention. A greater understanding of long-term recurrence and progression rates following complete or partial resection and the need for further intervention will help clinicians provide meaningful counsel for their patients and assist data-driven decision-making.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors retrospectively analyzed their institutional database for patients undergoing endoscopic endonasal surgery (EES) for nonfunctioning pituitary macroadenomas (2003–2014). Only patients with follow-up of at least 5 years after surgery were included. Tumor volumes were measured on pre- and postoperative MRI. Tumor recurrence was defined as the presence of a 0.1-cm<jats:sup>3</jats:sup> tumor volume after GTR, and tumor progression was defined as a 25.0% increase in residual tumor after STR.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 190 patients were included, with a mean age of 63.8 ± 13.2 years; 79 (41.6%) were female. The mean follow-up was 75.0 ± 18.0 months. GTR was achieved in 127 (66.8%) patients. In multivariate analysis, age (p = 0.04), preoperative tumor volume (p = 0.03), Knosp score (p &lt; 0.001), and Ki-67 (p = 0.03) were significant predictors of STR. In patients with GTR, the probability of recurrence at 5 and 10 years was 3.9% and 4.7%, and the probability of requiring treatment for recurrence was 0.79% and 1.6%, respectively. In 63 patients who underwent STR, 6 (9.5%) received early postoperative radiation and did not experience progression, while the remaining 57 (90.5%) were observed. Of these, the probability of disease progression at 5 and 10 years was 21% and 24.5%, respectively, and the probability of requiring additional treatment for progression was 17.5% and 21%. Predictors of recurrence or progression in the entire group were Knosp score (p &lt; 0.001) and elevated Ki-67 (p = 0.03). Significant predictors of progression after STR in those who did not receive early radiotherapy were cavernous sinus location (p &lt; 0.05) and tumor size &gt; 1.0 cm<jats:sup>3</jats:sup> (p = 0.005).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Following GTR for nonfunctioning pituitary adenomas, the 10-year chance of recurrence is low and the need for treatment even lower. After STR, although upfront radiation therapy may prevent progression, even without radiotherapy, the need for intervention at 10 years is only approximately 20% and a period of observation may be warranted to prevent unnecessary prophylactic radiation therapy. Tumor volume &gt; 1 cm<jats:sup>3</jats:sup>, Knosp score ≥ 3, and Ki-67 ≥ 3% may be useful metrics to prompt closer follow-up or justify early prophylactic radiation therapy.</jats:p></jats:sec>

Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency

“…Furthermore, an overall beneficial effect on pituitary hormone secretion was found. The maximum numbers of post-surgery new insufficiencies per axis was 10% which is in accordance with previous papers reporting data on deterioration of pituitary function 20,21,24,27 . Analogous to other studies we identified tumour size as a predictor of post-surgery insufficiency for the 3 investigated pituitary axis 6,26,27 .…”

“…al. 20 also found an increased risk at developing anterior pituitary dysfunction after reoperations (n=19), however it was not specific for the adrenal axis as seen in the present study. By contrast, Chang et.…”

A Nomogram for Preoperatively Predicting the Ki-67 Index of a Pituitary Tumor: A Retrospective Cohort Study

“…A high Ki-67 index requires neurosurgeons to obtain gross-total resection and prepare for higher probability of compression and tissue adhesion in the surrounding structures (6). Furthermore, a high Ki-67 index may prompt a closer follow-up or early radiation therapy (7). Ugga et al proposed a machine learning model based on T2W magnetic resonance imaging (MRI) for the prediction of the Ki-67 proliferation index class (8).…”

Role of Pituitary Stalk and Gland Radiological Status on Endocrine Function and Outcomes after Endoscopic Transsphenoidal Surgery for Non-functioning Pituitary Adenomas

“…Another factor to take into account, although it is outside the objective of this study, would be tumour hardness [33]. On the other hand, we observed that GTR protects against postoperative hormonal worsening, and it is known that there are higher GTR rates when the tumour volume is lower [22] [34], as demonstrated in our study. We would say that patients in whom pituitary gland is visualized on preoperative MRI, with smaller tumour size and in which GTR is achieved, are the ones more likely of having at least hormonal stability after surgery with a smaller number of axes affected.…”