Validation of a clinicopathological score for the prediction of post-surgical evolution of pituitary adenoma: retrospective analysis on 566 patients from a tertiary care centre

Abstract

Objective and design: A clinicopathological score has been proposed by Trouillas et al. to predict the evolution of pituitary adenomas. Aim of our study was to perform an independent external validation of this score and identify other potential predictor of post-surgical outcome. Methods: The study sample included 566 patients with pituitary adenomas, specifically 253 FSH/LH-secreting, 147 GH-secreting, 85 PRL-secreting, 72 ACTH-secreting and 9 TSH-secreting tumours with at least 3-year post-surgical follow-up. Results: In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumours were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL-, ACTH-and FSH/LH-secreting tumours as compared to those with somatotroph tumours, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed tumour type and grade to be independent predictors of disease-free-survival. Tumour invasion, Ki-67 and tumour type were the only independent prognostic factors of disease-free survival. Conclusions: Our data confirmed the validity of Trouillas' score, being tumour type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumour histological subtype, in the clinical setting to early identify patients at higher risk of recurrence.

Invited Review: Pathology of pituitary neuroendocrine tumours: present status, modern diagnostic approach, controversies and future perspectives from a neuropathological and clinical standpoint

“…Despite improvements, the WHO classification still lacks significant prognostic impact. Recent retrospective and prospective studies on large number of patients operated on for pituitary neuroendocrine tumours have demonstrated that combined use of proliferative markers and tumour invasion as a five‐tiered score strongly predicts persistent tumour disease and early progression/recurrence after surgery . Based on the published studies, it is to be expected that inclusion of both cell proliferation and tumour invasion, as previously proposed , in combination with the definition of potentially aggressive histological subtypes, would significantly improve prognostic and predictive value of the WHO classification of pituitary neuroendocrine tumours.…”

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

“…Surgical observations have the fundamental role of providing data for diagnosis of extension or invasion of PAs [7,[58][59][60][61].…”

“…To overcome these limits, a grading system based on the combination of clinical and histopathological features, which correlates with high accuracy with the clinical outcome in term of recurrence rate and disease persistence, has been recently proposed by Trouillas et al [137]. This system has been validated in independent reports [61,138] and included as integrated diagnostic information within the algorithm proposed for a standardized diagnostic approach to PitNETs by the European Pituitary Pathology Group (EPPG) [139]. The proposed grading system is basically founded on three major tumor features related to tumor size, proliferation, and invasiveness, while expression of p53, previously adopted as a potential marker of PitNET aggressiveness, has been confined to a minor role, since the low frequency of p53 detection by immunohistochemistry indicates that it is inadequate as a routine marker of invasiveness.…”

How and when to use temozolomide to treat aggressive pituitary tumours

“…The overall grade is determined by whether the tumours are invasive (1 or 2) and/or proliferative (a or b). The combination of both invasion and proliferation (grade 2b) strongly predicts recurrence or progression (Asioli et al 2019).…”