California Center for Pituitary Disorders, University of California, 400 Parnassus Avenue, Room A-808, San Francisco, CA 94143-0350, USA.
Pituitary. 2011 Sep;14(3):276-83. doi: 10.1007/s11102-011-0308-1.
The importance of achieving tumor control in pituitary adenoma surgery is not entirely established. This manuscript reviews the literature linking residual pituitary tumor and hormonal hypersecretion to increases in long term mortality. When possible, we utilized meta-analysis methods to estimate a pooled standardized mortality ratio (SMR), which relates the risk of mortality for a cohort of patients compared to a similar age and gender matched cohort in the general population, for patients with endocrinologic evidence of residual disease. When this was not possible, we review the existing literature in the results and discussion section of this review. We identified 10 articles regarding acromegaly and three articles regarding Cushing's disease which presented SMR data for adult patients undergoing transphenoidal surgery with data divided into subgroups based on post-operative growth hormone levels. Using growth hormone levels of 2.5 μg/l as a cutoff, the mortality rate ratio was 1.83 (95% CI = 1.03-3.24) for patients with persistent acromegaly. Similarly, patients with persistent Cushing's disease experienced a marked increase in mortality rate ratio compared to those experiencing initial cure (mortality rate ratio = 3.25 (95% CI = 1.54-6.84). For other tumor subtypes, (i.e. Endocrine inactive adenomas, Prolactinomas, and TSH secreting tumors) there were not enough studies identified to allow for rigorous statistical analysis. There is an increasing body of data suggesting that treatment refractory acromegaly and Cushing's disease puts patients at risk for early mortality, suggesting that aggressive efforts to normalize hormone levels in these patients are justified.
在垂体腺瘤手术中实现肿瘤控制的重要性尚未完全确定。本文综述了将残余垂体肿瘤和激素分泌过多与长期死亡率增加联系起来的文献。在可能的情况下，我们利用荟萃分析方法来估计标准化死亡率比（SMR）的汇总值，该比值将患者队列的死亡风险与一般人群中年龄和性别相匹配的类似队列进行比较，用于有内分泌学证据表明存在残余疾病的患者。在不可能的情况下，我们在本综述的结果和讨论部分回顾了现有的文献。我们确定了 10 篇关于肢端肥大症的文章和 3 篇关于库欣病的文章，这些文章为接受经蝶窦手术的成年患者提供了 SMR 数据，并根据术后生长激素水平将数据分为亚组。使用 2.5μg/l 作为生长激素水平的截止值，持续肢端肥大症患者的死亡率比值为 1.83（95%置信区间为 1.03-3.24）。同样，与初始治愈的患者相比，持续库欣病患者的死亡率比值显著增加（死亡率比值为 3.25（95%置信区间为 1.54-6.84））。对于其他肿瘤亚型（即无功能腺瘤、催乳素瘤和 TSH 分泌瘤），没有足够的研究可以进行严格的统计学分析。越来越多的数据表明，治疗抵抗性肢端肥大症和库欣病使患者面临早期死亡的风险，这表明积极努力使这些患者的激素水平正常化是合理的。
