Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Chengdu, China.
Endocrine. 2019 Nov;66(2):310-318. doi: 10.1007/s12020-019-02029-1. Epub 2019 Jul 31.
Although well-documented from pathological aspect, the clinical features and outcomes of acromegaly with mammosomatotroph (MSA) and mixed somatotroph-lactotroph adenoma (MSLA) are seldom reported. Thus, in this study, we analyzed and reported the clinical data about MSAs and MSLAs.
We retrospectively reviewed medical records of patients with acromegaly in our institution during 2008-2017. Growth hormone (GH)-secreting adenomas were categorized into pure somatotroph adenoma (PSA), MSA and MSLA based on inclusion and exclusion criteria. Clinical information and treatment outcomes during follow-up were analyzed by univariate and multivariate methods.
Among 94 patients within this cohort, PSAs, MSAs, and MSLAs accounted for 53, 28 and 13 cases, respectively. MSAs often had smaller size, lower frequency of cavernous sinus invasion and higher gross total resection (GTR) rate. MSLAs were characterized by bigger tumor size, higher frequency of preoperative hyperprolactinemia, and lower GTR rate. Thus, MSLAs had worse long-term biological remission rate than MSAs and PSAs (15.4% vs. 50.0% and 26.4%, p = 0.0371). Gender (male, OR = 0.784, p = 0.011) and tumor volume (OR = 0.784, p = 0.020) were independent predictors for long-term biological remission in binary logistic regression. Subgroup analyses indicated that postoperative nadir GH level (GH-7, HR = 1.242, p = 0.001) was the only risk factor for tumor recurrence for patients with GTR.
Our results provide valuable insights into clinicopathological features of acromegaly. MSAs were relatively smaller lesions with better prognosis. MSLAs were more aggressive with massive size, invasiveness and preoperative hyperprolactinemia. Tumor size and GH-7 were significantly associated with biological remission and tumor relapse after GTR, respectively.
尽管从病理学角度对肢端肥大症伴乳生长激素-泌乳素细胞腺瘤（MSA）和混合生长激素-泌乳素细胞腺瘤（MSLA）已有充分的文献记载，但此类疾病的临床表现和结局仍鲜有报道。因此，本研究分析并报告了此类 MSA 和 MSLA 的临床数据。
我们对 2008 年至 2017 年期间在我院就诊的肢端肥大症患者的病历进行了回顾性分析。根据纳入和排除标准，将生长激素（GH）分泌性腺瘤分为单纯生长激素腺瘤（PSA）、MSA 和 MSLA。通过单变量和多变量方法分析了随访期间的临床信息和治疗结果。
在这一队列的 94 例患者中，PSA、MSA 和 MSLA 分别占 53、28 和 13 例。MSA 通常体积较小，海绵窦侵袭率较低，大体全切除（GTR）率较高。MSLA 的特点是肿瘤体积较大，术前高泌乳素血症发生率较高，GTR 率较低。因此，MSLA 的长期生物学缓解率低于 MSA 和 PSA（15.4%比 50.0%和 26.4%，p=0.0371）。二元逻辑回归分析显示，性别（男性，OR=0.784，p=0.011）和肿瘤体积（OR=0.784，p=0.020）是长期生物学缓解的独立预测因素。亚组分析表明，GTR 患者术后的 GH 水平最低点（GH-7，HR=1.242，p=0.001）是肿瘤复发的唯一危险因素。
我们的研究结果为肢端肥大症的临床病理特征提供了有价值的见解。MSA 是相对较小的病变，预后较好。MSLA 则更为侵袭性，体积较大，侵袭性强，术前高泌乳素血症发生率高。肿瘤大小和 GH-7 与 GTR 后生物学缓解和肿瘤复发显著相关。
