Erfurth Eva Marie, Bulow Birgitta, Nordström Carl-Henrik, Mikoczy Zoli, Hagmar Lars, Strömberg Ulf
Department of Internal Medicine, Division of Diabetology and Endocrinology, Lund University Hospital, S-221 85 Lund, Sweden.
Eur J Endocrinol. 2004 Apr;150(4):497-502. doi: 10.1530/eje.0.1500497.
Reduced life expectancy has been shown in patients with hypopituitarism, mainly caused by cardiovascular diseases. A major cause of hypopituitarism is pituitary adenomas, and radiotherapy may be employed as a treatment modality to reduce the post-operative regrowth rate of these tumours. Recently, we showed that in patients with craniopharyngiomas, tumour regrowth foreshadowed a fourfold risk increase for death. For patients with pituitary adenomas, the impact of regrowth on life expectancy is, however, not known.
To assess the impact of a reoperation due to a regrowth of a pituitary macroadenoma on mortality, taking into account other candidate prognostic factors.
In 281 patients with operated and irradiated macroadenomas, excluding acromegaly and Cushing's disease, 35 patients had a regrowth (median follow-up 16.6 years). Possible risk factors for tumour regrowth were investigated by Cox regression models.
For tumour regrowth, age, calendar time at primary surgery, gender and extension of tumour growth had no statistically significant impact. For younger patients, the proportion of regrowths was higher, but after age-stratified Cox regression analysis only regrowth was shown to have a significant impact on mortality, with a more than doubled mortality risk for patients with tumour regrowth as compared with the non-regrowing tumour patients (hazard ratio=2.24, P<0.001). This finding was corroborated by cohort analyses using the general population as an external comparison group.
Among patients with irradiated pituitary macroadenomas, excluding acromegaly and Cushing's disease, a doubled mortality rate was observed for those reoperated for tumour regrowth as compared with patients with non-regrowing tumours.
垂体功能减退患者的预期寿命缩短，主要原因是心血管疾病。垂体功能减退的一个主要原因是垂体腺瘤，放射治疗可作为一种治疗方式来降低这些肿瘤的术后复发率。最近，我们发现颅咽管瘤患者中，肿瘤复发预示着死亡风险增加四倍。然而，对于垂体腺瘤患者，复发对预期寿命的影响尚不清楚。
考虑其他潜在预后因素，评估因垂体大腺瘤复发而再次手术对死亡率的影响。
在281例接受手术和放疗的大腺瘤患者中，排除肢端肥大症和库欣病患者，35例出现复发（中位随访时间16.6年）。通过Cox回归模型研究肿瘤复发的可能危险因素。
对于肿瘤复发，年龄、初次手术时间、性别和肿瘤生长范围均无统计学显著影响。年轻患者的复发比例较高，但在按年龄分层的Cox回归分析后，仅复发被证明对死亡率有显著影响，与未复发肿瘤的患者相比，肿瘤复发患者的死亡风险增加一倍以上（风险比=2.24，P<0.001）。使用一般人群作为外部比较组的队列分析证实了这一发现。
在接受放疗的垂体大腺瘤患者中，排除肢端肥大症和库欣病患者，因肿瘤复发而再次手术的患者与未复发肿瘤的患者相比，死亡率增加一倍。
