Jaquet Ph, Cortet-Rudelli Ch, Sassolas G, Morange-Ramos I, Chanson P, Brue Th, Andrieu J-M, Beckers A, Bertherat J, Borson-Chazot F, Brassier G, Caron Ph, Cogne M, Cottier J-Ph, Delemer B, Dufour H, Enjalbert A, Figarella-Branger D, Gaillard R, Gueydan M, Jan M, Kuhn J-M, Raingeard I, Regis J, Roger P, Rohmer V, Sadoul J-L, Saveanu A, Tabarin A, Travers N, Trouillas J
Service d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille.
Ann Endocrinol (Paris). 2003 Dec;64(6):434-41.
From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05).
46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.
从纳入法国肢端肥大症登记处的前198份患者档案中，我们分析了68例患有生长激素腺瘤且有鞍外扩展的患者，排除了接受立体定向或传统放疗的患者。这些患者（包括37名女性）年龄在21 - 77岁（45.7±13.3），生长激素浓度范围为2 - 260μg/L（38.6±44.3），胰岛素样生长因子I为年龄匹配正常上限的86 - 967%（303±164）。磁共振成像（MRI）显示腺瘤最大直径为11 - 36.5mm（20.4±6.5），68%的病例有海绵窦受累。定义了三个亚组：20例仅接受长效生长抑素类似物治疗的患者（M组），平均治疗时间为3年（范围1 - 7年）；48例最初接受经蝶窦手术的患者（C组），其中21例随后接受长效生长抑素类似物治疗（CM组），平均治疗时间为1.2年（范围0.2 - 2年）。三组在肿瘤大小以及生长激素和胰岛素样生长因子 - 1的初始水平方面无统计学差异。M组患者明显比其他组患者年龄大（p<0.05）。
C组术后46%的患者与M组45%的患者平均生长激素低于2.5μg/L。C组31%的病例实现了生化缓解（生长激素<2.5μg/L且胰岛素样生长因子1正常），M组为25%。在该组中，10例患者（71.5%）观察到最大肿瘤直径减小，7例（50%）减小幅度为10 - 25%，3例（21.5%）超过50%。CM组的生化缓解率（42%）以及最终生长激素或胰岛素样生长因子1值与M组无显著差异。总之，这些数据表明，在伴有鞍外扩展的生长激素大腺瘤的缓解率方面，手术或长效生长抑素类似物具有相当的疗效。
