Tampourlou Metaxia, Ntali Georgia, Ahmed Shahzada, Arlt Wiebke, Ayuk John, Byrne James V, Chavda Swarupsinh, Cudlip Simon, Gittoes Neil, Grossman Ashley, Mitchell Rosalind, O'Reilly Michael W, Paluzzi Alessandro, Toogood Andrew, Wass John A H, Karavitaki Niki
Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham B15 2TT, Birmingham, United Kingdom.
Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, United Kingdom.
J Clin Endocrinol Metab. 2017 Jun 1;102(6):1889-1897. doi: 10.1210/jc.2016-4061.
Despite the major risk of regrowth of clinically nonfunctioning pituitary adenomas (CNFAs) after primary treatment, systematic data on the probability of further tumor progression and the effectiveness of management approaches are lacking.
To assess the probability of further regrowth(s), predictive factors, and outcomes of management approaches in patients with CNFA diagnosed with adenoma regrowth after primary treatment.
PATIENTS, DESIGN, AND SETTING: Retrospective cohort study of 237 patients with regrown CNFA managed in two UK centers.
Median follow-up was 5.9 years (range, 0.4 to 37.7 years). The 5-year second regrowth rate was 35.3% (36.2% after surgery; 12.5% after radiotherapy; 12.7% after surgery combined with radiotherapy; 63.4% with monitoring). Of those managed with monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for second regrowth. Among those with second adenoma regrowth, the 5-year third regrowth rate was 26.4% (24.4% after surgery; 0% after radiotherapy; 0% after surgery combined with radiotherapy; 48.3% with monitoring). Overall, patients with a CNFA regrowth had a 4.4% probability of a third regrowth at 5 years and a 10.0% probability at 10 years; type of management of the first regrowth was the only risk factor. Malignant transformation was diagnosed in two patients.
Patients with regrown CNFA after primary treatment continue to carry considerable risk of tumor progression, necessitating long-term follow-up. Management approach to the regrowth was the major factor determining this risk; monitoring had >60% risk of progression at 5 years, and a substantial number of patients ultimately required intervention.
尽管临床无功能垂体腺瘤（CNFAs）在初次治疗后有复发的主要风险，但关于肿瘤进一步进展的可能性以及管理方法有效性的系统性数据仍然缺乏。
评估初次治疗后诊断为腺瘤复发的CNFA患者进一步复发的可能性、预测因素以及管理方法的结果。
患者、设计与研究地点：对英国两个中心管理的237例复发CNFA患者进行回顾性队列研究。
中位随访时间为5.9年（范围0.4至37.7年）。5年二次复发率为35.3%（手术治疗后为36.2%；放疗后为12.5%；手术联合放疗后为12.7%；观察等待为63.4%）。在接受观察等待的患者中，最终有34.8%的患者接受了干预。管理方法类型和性别是二次复发的危险因素。在出现二次腺瘤复发的患者中，5年三次复发率为26.4%（手术治疗后为24.4%；放疗后为0%；手术联合放疗后为0%；观察等待为48.3%）。总体而言，CNFA复发患者5年三次复发概率为4.4%，10年为10.0%；首次复发的管理方法是唯一的危险因素。两名患者被诊断为恶性转化。
初次治疗后复发的CNFA患者仍有相当大的肿瘤进展风险，需要长期随访。复发的管理方法是决定这一风险的主要因素；观察等待在5年时进展风险>60%，并且相当数量的患者最终需要干预。
