Endocrinology Research Centre, 11 Dm. Ulyanova str., 117036, Moscow, Russia.
National Research University Higher School of Economics, 20 Myasnitskaya Ul., 101000, Moscow, Russia.
Pituitary. 2019 Dec;22(6):574-580. doi: 10.1007/s11102-019-00985-5.
Some laboratory and clinical features are associated with a probability of recurrence after transnasal adenomectomy for Cushing disease (CD). However, there is no consensus on a set of predictors. Rules for prediction of recurrence were not proposed earlier.
To develop prediction model of recurrence/remission after successful neurosurgical treatment for CD.
Retrospective single-site comparative study included 349 patients (52 men and 297 women) with a verified diagnosis of CD who underwent effective endoscopic transsphenoidal adenomectomy between 2007 and 2014. Clinical and laboratory parameters were evaluated. Laboratory tests were performed using immunochemiluminescent method. Time-to-event analysis and ROC-analysis were applied. Multivariate models were developed using logistic regression and artificial neural network (ANN).
Postoperative cortisol and ACTH levels and their combinations cannot be used for prediction of recurrence. ANN for prediction of recurrence within 3 years after successful surgery was developed. Input variables are age, duration of the disease, MRI data on adenoma, morning postoperative levels of ACTH and cortisol, output variable is binary (recurrence/remission). Predictive value for remission is 93%, 95% CI [89%; 96%], and predictive value for recurrence is 85%, 95% CI [71%; 94%]. Web-calculator based on the model is developed and free for use.
Effective method for prediction of recurrence and long-term remission within 3 years after successful endoscopic transsphenoidal adenomectomy is proposed.
一些实验室和临床特征与经鼻蝶窦切除术治疗库欣病（CD）后的复发概率相关。然而，目前尚未达成关于预测指标的共识。此前也没有提出用于预测复发的规则。
为经神经外科治疗成功的 CD 患者制定术后复发/缓解的预测模型。
这项回顾性单中心对照研究纳入了 2007 年至 2014 年间接受有效内镜经蝶窦腺瘤切除术的 349 例（男 52 例，女 297 例）确诊 CD 患者。评估了临床和实验室参数。采用免疫化学发光法进行实验室检测。应用时间事件分析和 ROC 分析。使用逻辑回归和人工神经网络（ANN）开发多变量模型。
术后皮质醇和 ACTH 水平及其组合不能用于预测复发。开发了用于预测成功手术后 3 年内复发的 ANN。输入变量为年龄、疾病持续时间、腺瘤的 MRI 数据、术后清晨 ACTH 和皮质醇水平，输出变量为二分类（复发/缓解）。缓解的预测值为 93%，95%CI [89%；96%]，复发的预测值为 85%，95%CI [71%；94%]。基于该模型开发了免费的网络计算器。
提出了一种预测内镜经蝶窦切除术成功后 3 年内复发和长期缓解的有效方法。
