Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France.
Assistance Publique-Hôpitaux de Marseille (AP-HM), Department of Endocrinology, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13005, Marseille, France.
Pituitary. 2018 Dec;21(6):615-623. doi: 10.1007/s11102-018-0916-0.
To determine whether pre-surgical medical treatment (PSMT) using long-acting Somatostatin analogues in acromegaly may improve long-term surgical outcome and to determine decision making criteria.
This retrospective study included 110 consecutive patients newly diagnosed with acromegaly, who underwent surgery in a reference center (Marseille, France). The mean long-term follow-up period was 51.4 ± 36.5 (median 39.4) months. Sixty-four patients received PSMT during 3-18 (median 5) months before pituitary surgery. Remission was defined at early (3 months) evaluation and at last follow-up by GH nadir after oral glucose tolerance test < 0.4 µg/L and normal IGF-1.
Pretreated and non-pretreated groups were comparable for the main confounding factors except for higher IGF-1 at diagnosis in PSMT patients. Remission rates were significantly different in pretreated or not pretreated groups (61.1% vs. 36.6%, respectively at long-term evaluation). In multivariate analysis, PSMT was significantly linked to 3 months (p < 0.01) and long-term remission (p < 0.01). Duration of PSMT was not significantly different in cured or non-cured patients, at both evaluation times. PSMT appeared to be more beneficial for patients with an invasive tumor. No patient with a tumor greater than 18 mm or mean GH level exceeding 35 ng/mL at diagnosis was cured by surgery alone (vs. 8 and 9 patients in the pretreated group, respectively). Patients with PSMT showed more transient mild hyponatremia after surgery.
PSMT significantly improved short and long-term remission in patients with acromegaly, independent of its duration, especially in invasive adenomas.
确定肢端肥大症患者术前使用长效生长抑素类似物（Somatostatin analogues）的治疗（Pre-surgical medical treatment，PSMT）是否能改善长期手术效果，并确定决策标准。
本回顾性研究纳入了 110 例在法国马赛的参考中心新诊断为肢端肥大症的连续患者。平均长期随访时间为 51.4±36.5（中位数 39.4）个月。64 例患者在垂体手术前 3-18 个月（中位数 5 个月）接受 PSMT。早期（3 个月）评估和最后随访时，通过口服葡萄糖耐量试验后 GH 谷值<0.4μg/L 和正常 IGF-1 来定义缓解。
除 PSMT 患者的 IGF-1 诊断值较高外，预处理和未预处理组在主要混杂因素方面无差异。预处理组和未预处理组的缓解率在长期评估时差异显著（分别为 61.1%和 36.6%）。多变量分析表明，PSMT 与 3 个月（p<0.01）和长期缓解（p<0.01）显著相关。在两个评估时间点，治愈或未治愈患者的 PSMT 持续时间均无显著差异。PSMT 似乎对侵袭性肿瘤患者更有益。仅手术不能治愈肿瘤大于 18mm 或诊断时平均 GH 水平超过 35ng/mL 的患者（分别与预处理组的 8 例和 9 例患者相比）。PSMT 患者术后出现更多短暂的轻度低钠血症。
PSMT 显著改善了肢端肥大症患者的短期和长期缓解，与持续时间无关，尤其是侵袭性腺瘤。
