Turner H E, Stratton I M, Byrne J V, Adams C B, Wass J A
Departments of Endocrinology, Radcliffe Infirmary, Oxford, UK.
Clin Endocrinol (Oxf). 1999 Sep;51(3):281-4. doi: 10.1046/j.1365-2265.1999.00865.x.
Non-functioning pituitary adenomas (NFA) are the commonest type of pituitary macroadenoma. Although the initial definitive management of these tumours is almost always trans-sphenoidal surgery, the use of postoperative radiotherapy remains controversial. Radiotherapy has been shown to significantly reduce the risk of tumour regrowth. An audit of patients with NFAs treated with trans-sphenoidal surgery without irradiation was performed at our centre five years ago, and suggested that careful selection and follow-up could avoid the need for adjuvant radiotherapy. We have repeated this audit to assess the longer term effects of this management strategy.
The case notes and imaging of the original cohort of 65 of 73 patients (50 males, mean age 52) who had undergone trans-sphenoidal surgery (TSA) for NFA between July 1979 and 1992, had not received irradiation and were followed up by imaging were reviewed. Tumour regrowth was defined as enlargement of the pituitary tumour. Mean follow-up was 76 months (range 12-173).
Pituitary tumour regrowth has occurred in 21 of the 65 patients (32%) during a mean follow-up of 76 months compared with 8/73 (11%) in 1994 (P = 0.002). The tumour regrowth was detected at a mean of 5.4 years (range 2-14 years). Lifetable analysis of the whole unirradiated group showed 82% recurrence free survival at 5 years (95% confidence limits 72-92%), and 56% at 10 years (95% confidence limits 38-74%). Eight (12%) patients required a second surgical procedure (6 TSA and 2 craniotomies). There was no relationship between recurrence and whether a total surgical removal was thought to have been performed.
Despite careful selection of patients with non-functioning pituitary adenomas, tumour regrowth occurs in a significant proportion. These results show that continued follow-up in these patients is essential as significantly more patients showed evidence of tumour regrowth at this second assessment compared with the 1994 data. Until we are able to predict which tumours are likely to regrow postoperatively, radiotherapy should be considered for all patients with non-functioning pituitary adenomas as even in carefully selected cases, the regrowth rate is approaching 50% at 10 years.
无功能垂体腺瘤（NFA）是最常见的垂体大腺瘤类型。尽管这些肿瘤最初的确定性治疗几乎总是经蝶窦手术，但术后放疗的应用仍存在争议。放疗已被证明能显著降低肿瘤复发风险。5年前我们中心对接受经蝶窦手术且未接受放疗的NFA患者进行了一次审计，结果表明仔细的选择和随访可以避免辅助放疗的需要。我们再次进行了这项审计，以评估这种管理策略的长期效果。
回顾了1979年7月至1992年间因NFA接受经蝶窦手术（TSA）、未接受放疗且通过影像学进行随访的73例患者中65例（50例男性，平均年龄52岁）的病历和影像学资料。肿瘤复发定义为垂体肿瘤增大。平均随访时间为76个月（范围12 - 173个月）。
在平均76个月的随访期间，65例患者中有21例（32%）出现垂体肿瘤复发，而1994年73例中有8例（11%）复发（P = 0.002）。肿瘤复发平均出现在5.4年（范围2 - 14年）。对整个未接受放疗组的生存表分析显示，5年时无复发生存率为82%（95%置信区间72 - 92%），10年时为56%（95%置信区间38 - 74%）。8例（12%）患者需要进行二次手术（6例经蝶窦手术和2例开颅手术）。复发与是否认为已进行了全切手术之间没有关系。
尽管对无功能垂体腺瘤患者进行了仔细选择，但仍有相当比例的患者出现肿瘤复发。这些结果表明，对这些患者持续随访至关重要，因为与1994年的数据相比，在这次二次评估中有更多患者出现肿瘤复发的证据。在我们能够预测哪些肿瘤术后可能复发之前，所有无功能垂体腺瘤患者都应考虑放疗，因为即使在仔细选择的病例中，10年时的复发率也接近50%。
