Neuroendocrinology Research Center / Endocrinology Division - Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Radiology Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
Endocrine. 2018 Jun;60(3):415-422. doi: 10.1007/s12020-018-1590-8. Epub 2018 Apr 6.
Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery.
To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier.
Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission.
Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity.
Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.
经蝶窦手术（TSS）是治疗肢端肥大症的基石，然而目前尚无可靠的手术结果预测指标，且缓解只能在手术后三个月定义。
分析生化、人口统计学、影像学和免疫组织化学特征是否是手术缓解的预测指标，并探讨术后即刻 GH 和 IGF-I 水平是否有助于更早定义缓解。
评估了 2013-2016 年间接受 TSS 的连续肢端肥大症患者。缓解标准定义为术后三个月 IGF-I 和 GH<1mcg/L。将年龄、性别、GH 和 IGF-I 水平、肿瘤体积、海绵窦侵犯、T2 加权信号、Ki-67 和颗粒状模式与缓解状态相关联。评估术后 24、48 小时和一周时的 GH 和 IGF-I 水平作为缓解的早期标准。
共纳入 69 例患者（84%为大腺瘤），45 例获得手术缓解。在治愈和未治愈患者之间，年龄、性别、术前 GH 或 IGF-I 水平、肿瘤体积、T2 加权信号、Ki-67 和肿瘤颗粒度无差异。非侵袭性肿瘤中有 20 例（56%）和侵袭性肿瘤中有 3 例（19%）获得缓解（p=0.017）。术后 48 小时 GH<1.57mcg/L 可预测缓解，其敏感性为 93%，特异性为 86%；术后一周 IGF-I<231%ULNR 可预测缓解，其敏感性为 86%，特异性为 93%。
海绵窦侵犯是手术缓解的唯一术前预测指标。术后 48 小时 GH 和一周 IGF-I 可更早定义未治愈患者。
