内分泌疾病的治疗：库欣病患者经蝶窦手术的结局：评估用于定义缓解和复发的标准的系统评价

Therapy of endocrine disease: outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence.

作者信息

Petersenn Stephan, Beckers Albert, Ferone Diego, van der Lely Aart, Bollerslev Jens, Boscaro Marco, Brue Thierry, Bruzzi Paolo, Casanueva Felipe F, Chanson Philippe, Colao Annamaria, Reincke Martin, Stalla Günter, Tsagarakis Stelios

机构信息

ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece

出版信息

Eur J Endocrinol. 2015 Jun;172(6):R227-39. doi: 10.1530/EJE-14-0883. Epub 2015 Jan 19.

DOI:10.1530/EJE-14-0883

PMID:25599709

Abstract

OBJECTIVE

A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence.

METHODS

We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed.

RESULTS

Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience.

CONCLUSIONS

The variety of methodologies used in clinical evaluation of TSS for Cushing's disease strongly support the call for standardization and optimization of studies to inform clinical practice and maximize patient outcomes. Clinically significant rates of failure of initial TSS highlight the need for effective second-line treatments.

摘要

目的

多种因素会影响库欣病经蝶窦手术（TSS）报告的结果，包括不同的缓解和复发标准，对此尚无共识。因此，对最佳治疗方案和患者管理策略进行比较分析很困难。在本综述中，我们基于缓解和复发的定义及评估，研究了库欣病患者初次TSS的临床结果。

方法

我们系统检索了 PubMed，确定了 44 项对缓解和复发有明确定义的研究。如有数据，还按缓解时间、肿瘤大小、随访时间、手术经验、研究发表年份以及与手术相关的不良事件进行了额外分析。

结果

提取并分析了总共 6400 例接受显微镜下 TSS 患者的数据。初次显微镜下 TSS 后库欣病缓解和复发的定义多种多样，缓解率范围广泛（42.0 - 96.6%；中位数为 77.9%），复发率范围为（0 - 47.4%；中位数为 11.5%）。微腺瘤的缓解和复发结果优于大腺瘤；然而，除了手术经验越长安全性越高外，未发现与其他参数有相关性。