Øystese Kristin Astrid, Zucknick Manuela, Casar-Borota Olivera, Ringstad Geir, Bollerslev Jens
Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, P.b.4950 Nydalen, Oslo, 0424, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Endocrine. 2017 Jul;57(1):35-45. doi: 10.1007/s12020-017-1314-5. Epub 2017 May 17.
Non-functioning pituitary adenomas are common, and the treatment and follow-up of these patients represent a multidisciplinary challenge. First line treatment is transphenoidal surgery, with debulking or total removal of tumour. A substantial portion of the tumours relapse after surgery, and there is no consensus of how to follow these patients postoperatively. Our aim was to characterize the postoperative growth of non-functioning pituitary adenomas and correlate it to clinical and paraclinical data.
We retrospectively registered 52 patients operated for non-functioning pituitary adenomas, with four or more consecutive MR-investigations not interrupted by secondary treatment. Adenoma volumes were estimated by the Cavalieri principle with summation of manually drawn areas multiplied by slice interval. Growth curves were modelled and tumour volume doubling time was calculated for 39 tumours with regrowth after surgery.
A total of 13 tumours showed exponential growth, 10 linear growth and 16 logistic growth after surgery. The remaining 13 did not show regrowth of tumour. Seven of the exponential growing tumours underwent secondary surgery, compared to one and two of linear and logistic growing tumours (p = 0.03), respectively. Initial tumour volume doubling time was significantly lower in logistic growing tumours than in exponential growing tumours (p < 0.01). Men had tumours with lower tumour volume doubling time than women (p = 0.03). None of the tumours demonstrated signs of accelerated growth.
Residual tumours following surgery frequently grow. The logistic growing tumours had the fastest initial growth in our cohort. We found no indication of accelerated growth, whereby the tumour volume doubling time might be used to predict a "worst-case" scenario when planning follow-up of these patients.
无功能垂体腺瘤很常见，对这些患者的治疗和随访是一项多学科挑战。一线治疗是经蝶窦手术，切除肿瘤或全部切除肿瘤。相当一部分肿瘤术后会复发，对于术后如何随访这些患者尚无共识。我们的目的是描述无功能垂体腺瘤的术后生长情况，并将其与临床和辅助临床数据相关联。
我们回顾性登记了52例接受无功能垂体腺瘤手术的患者，他们连续进行了四次或更多次磁共振成像检查，且未被二次治疗打断。采用卡瓦列里原理估计腺瘤体积，即手动绘制区域的总和乘以切片间隔。对39例术后复发的肿瘤建立生长曲线模型并计算肿瘤体积倍增时间。
术后共有13例肿瘤呈指数生长，10例呈线性生长，16例呈逻辑生长。其余13例未显示肿瘤复发。指数生长的肿瘤中有7例接受了二次手术，而线性生长和逻辑生长的肿瘤分别为1例和2例（p = 0.03）。逻辑生长的肿瘤初始肿瘤体积倍增时间显著低于指数生长的肿瘤（p < 0.01）。男性肿瘤的体积倍增时间低于女性（p = 0.03）。所有肿瘤均未显示生长加速迹象。
手术后残留的肿瘤经常生长。在我们的队列中，逻辑生长的肿瘤初始生长最快。我们未发现生长加速的迹象，因此在规划这些患者的随访时，肿瘤体积倍增时间可用于预测“最坏情况”。
