Validation of a clinicopathological prognostic score for elderly patients undergoing endoscopic endonasal surgery for pituitary adenoma: a single center 10 years’ experience and review of the literature

Abstract

Objective Evaluate the effectiveness of surgery for pituitary adenomas in the elderly and the reliability of the Trouillas score in patients with ≥ 65 years old. Methods A single center retrospective observational study was conducted for the period 2012–2020 recruiting all the patients over 65 years old underwent to primary endoscopic endonasal removal of both functioning and non-functioning pituitary adenomas. Radiological and histopathological features were examined for classification. Time-to-relapse was estimated using Kaplan-Meier product limit. Results 103 patients were recruited. Mean age at surgery was 72.2 years (range 65–83). The majority of tumors were non-functioning macroadenomas (83%). A gross total resection (GTR) was achieved in 46/73 (63%) of young elderly (age 65–74) and 14/30 (47%) of old elderly (age ≥ 75). According to Trouillas' classification criteria, 57 tumors resulted to be grade 1a, 8 grade 1b, 33 grade 2a, and 5 grade 2b. The mean TTR was 32.3 months ± 18.5. Mitotic index (p = 0.024) and a Trouillas grade (p = 0.048) remained statistically significant at multivariate analysis. Patients with Trouillas grade 1a/2a showed better rates of TTR than patients with Trouillas grade 1b/2b (mean DFS: 82 vs 49 months, p = 0.006) although the number of patients representing the second group (13) demands a critical interpretation of the result. Conclusions The possibility to predict tumor’s regrowth can define different timing for follow-up and could justify a more aggressive surgical treatment even among elderly patients, aiming to achieve GTR and significantly reduce the need for redo surgery.