Institut National de la Santé et de la Recherche Médicale, Unité 842, Université de Lyon, Lyon 1, Unité Mixte de Recherche (UMR) S842, Faculté de Médecine Lyon-Est, F-69372 Lyon, Cedex 08, France.
J Clin Endocrinol Metab. 2010 Apr;95(4):1708-16. doi: 10.1210/jc.2009-1191. Epub 2010 Feb 17.
Predicting pituitary tumor behavior remains a challenge. This multiparameter investigation aimed to identify markers for recurrence and progression in prolactin tumors.
From a cohort of patients treated for prolactin tumors by surgery, we retrospectively studied clinical data, tumor characteristics, clinical outcome, and the expression of nine genes by quantitative RT-PCR.
This study included 94 patients (62 females and 32 men), with long postoperative follow-up periods (mean, 138 +/- 46 months); 54.3% of patients had a macro or giant adenoma. Tumors were classified into three pathological groups based on their radiological and histological characteristics (noninvasive, 61; invasive, 22; and aggressive-invasive, 11). Immediately after surgery, 60 patients (63.8%) went into remission (prolactin level normalization). Persistently elevated prolactin levels (36.2%) were associated with increasing age, male sex, high preoperative prolactin levels, large tumor size on univariate analysis, and invasion and pathological classification on univariate and multivariate (P = 8 x 10(-10) and 3 x 10(-8)) analysis. During follow-up, 19 patients (20%) had tumors that recurred or progressed under dopamine agonist treatment. Invasion and pathological classification were associated with recurrence or progression on univariate analysis. Seven genes (ADAMTS6, CRMP1, PTTG, ASK, CCNB1, AURKB, and CENPE) were associated with tumor recurrence or progression and five of these (ADAMTS6, CRMP1, ASK, CCNB1, and CENPE) were associated with the pathological classification.
This study identifies both the clinical and histological factors that relate to prolactin tumor recurrence or progression. Molecular markers give additional information for prognosis of such tumors. Altogether, our results could influence the management of patients with pituitary tumors.
预测垂体瘤的行为仍然是一个挑战。本多参数研究旨在确定催乳素瘤复发和进展的标志物。
我们从接受手术治疗催乳素瘤的患者队列中，回顾性研究了临床数据、肿瘤特征、临床结局以及通过定量 RT-PCR 检测的 9 种基因的表达。
本研究纳入了 94 例患者（62 例女性和 32 例男性），术后随访时间长（平均 138±46 个月）；54.3%的患者为大或巨大腺瘤。根据影像学和组织学特征，肿瘤分为三种病理类型（非侵袭性 61 例，侵袭性 22 例，侵袭性-侵袭性 11 例）。术后即刻，60 例患者（63.8%）达到缓解（催乳素水平正常化）。持续性高催乳素水平（36.2%）与年龄较大、男性、术前催乳素水平较高、肿瘤大小较大有关，单因素分析时与侵袭性和病理分类有关，多因素分析时与侵袭性和病理分类有关（P=8×10（-10）和 3×10（-8））。在随访期间，19 例（20%）患者在多巴胺激动剂治疗下肿瘤复发或进展。侵袭性和病理分类与单因素分析时的复发或进展有关。有 7 种基因（ADAMTS6、CRMP1、PTTG、ASK、CCNB1、AURKB 和 CENPE）与肿瘤复发或进展有关，其中 5 种基因（ADAMTS6、CRMP1、ASK、CCNB1 和 CENPE）与病理分类有关。
本研究确定了与催乳素瘤复发或进展相关的临床和组织学因素。分子标志物为这类肿瘤的预后提供了额外的信息。总之，我们的研究结果可能会影响垂体瘤患者的治疗管理。
