Université Lyon 1, Université de Lyon, Lyon, France.
Acta Neuropathol. 2013 Jul;126(1):123-35. doi: 10.1007/s00401-013-1084-y. Epub 2013 Feb 12.
Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.
垂体腺瘤目前根据组织学、免疫细胞化学和许多超微结构特征进行分类，但缺乏明确的预后相关性。我们研究了一种基于侵袭和增殖的新临床病理分级分类的预后价值。这项回顾性多中心病例对照研究包括 410 名接受垂体肿瘤手术且长期随访的患者。使用垂体磁共振成像诊断海绵窦或蝶窦侵袭，免疫细胞化学、细胞周期标志物（Ki-67、有丝分裂）和 p53，根据肿瘤大小（微、巨和巨大）、类型（PRL、GH、FSH/LH、ACTH 和 TSH）和分级（1a 级：非侵袭性，1b 级：非侵袭性和增殖性，2a 级：侵袭性，2b 级：侵袭性和增殖性，3 级：转移性）对肿瘤进行分类。通过两种多变量分析评估患者在 8 年随访时的状况与年龄、性别和分类之间的关系，评估疾病或无复发/进展状态。在手术后 8 年，195 名患者无疾病（对照组），215 名患者有疾病（病例组）。在 125 例病例中，肿瘤复发或进展。无疾病和无复发/进展状态的分析显示，年龄、肿瘤类型和分级在所有肿瘤类型中具有显著的预后价值（p<0.001;p<0.05），并且对每种肿瘤类型也是如此。侵袭性和增殖性肿瘤（2b 级）的预后较差，肿瘤持续存在或进展的概率分别增加 25 倍或 12 倍，而非侵袭性肿瘤（1a 级）。这种新的、易于使用的垂体内分泌肿瘤临床病理分级分类通过强烈预测术后完全缓解或肿瘤进展的概率，证明了其预后价值，从而可以帮助临床医生选择最佳的术后治疗方案。
