Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron F-69677, France.
Faculté de Médecine Lyon Est, Université Lyon 1, Lyon F-69372, France.
J Clin Endocrinol Metab. 2017 Sep 1;102(9):3368-3374. doi: 10.1210/jc.2017-00773.
Most pituitary neuroendocrine tumors (PitNETs) show benign behavior, but a substantial number are invasive, recur, or resist medical treatment. Based on a retrospective case-control study, we recently proposed a classification of PitNETs of prognostic relevance. This prospective study aims to test the value of this classification in an independent patient cohort.
All patients who underwent PitNET surgery from 2007 to 2012 in one single center were included. Using a grading system based on invasion on magnetic resonance imaging, immunocytochemical profile, Ki-67, mitotic index, and p53 positivity, tumors were classified. Progression-free survival of the graded tumors was calculated by the Kaplan-Meier method and compared using the log-rank test. A multivariate analysis, using a Cox regression model, was also performed.
In total, 365 patients had grade 1a PitNETs (51.2%), followed by grade 2a (32.3%), 2b (8.8%), and 1b tumors (7.7%). Of 213 patients with a follow-up, 42% had recurrent (n = 52) or progressive disease (n = 37) at 3.5 years. Grade was a significant predictor of progression-free survival (P < 0.001). Multivariate analysis indicated grade (P < 0.001), age (P = 0.035), and tumor type (P = 0.028) as independent predictors of recurrence and/progression. This risk was 3.72-fold higher for a grade 2b tumor compared with grade 1a tumor.
Our data suggest that classification of PitNETs into five grades is of prognostic value to predict postoperative tumor behavior and identifies patients who have a high risk of early recurrence or progression. It therefore will allow clinicians to adapt their therapeutic strategies and stratify patients in future clinical trials.
大多数垂体神经内分泌肿瘤（PitNETs）表现出良性行为，但相当数量的肿瘤具有侵袭性、复发或对药物治疗有抵抗。基于一项回顾性病例对照研究，我们最近提出了一种具有预后相关性的 PitNET 分类。本前瞻性研究旨在在独立的患者队列中验证该分类的价值。
纳入 2007 年至 2012 年在一家单中心接受 PitNET 手术的所有患者。使用基于磁共振成像侵袭性、免疫细胞化学特征、Ki-67、有丝分裂指数和 p53 阳性的分级系统对肿瘤进行分类。使用 Kaplan-Meier 方法计算分级肿瘤的无进展生存率，并使用对数秩检验进行比较。还使用 Cox 回归模型进行了多变量分析。
共有 365 例患者为 1a 级 PitNETs（51.2%），其次为 2a 级（32.3%）、2b 级（8.8%）和 1b 级肿瘤（7.7%）。在 213 例有随访的患者中，42%在 3.5 年内出现复发（n=52）或进展性疾病（n=37）。分级是无进展生存率的显著预测因子（P<0.001）。多变量分析表明，分级（P<0.001）、年龄（P=0.035）和肿瘤类型（P=0.028）是复发和/或进展的独立预测因素。与 1a 级肿瘤相比，2b 级肿瘤的风险增加了 3.72 倍。
我们的数据表明，将 PitNETs 分为五级具有预测术后肿瘤行为的预后价值，并确定了具有早期复发或进展高风险的患者。因此，它将使临床医生能够调整治疗策略，并在未来的临床试验中对患者进行分层。
