预测垂体神经内分泌肿瘤（PitNET）术后复发和进展的实用算法。

A practical algorithm to predict postsurgical recurrence and progression of pituitary neuroendocrine tumours (PitNET)s.

机构信息

IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.

出版信息

Clin Endocrinol (Oxf). 2020 Jul;93(1):36-43. doi: 10.1111/cen.14197. Epub 2020 May 5.

DOI:10.1111/cen.14197

PMID:32306401

Abstract

OBJECTIVE

Pituitary neuroendocrine tumours (PitNET)s can be aggressive, thus presenting local invasion, postsurgical recurrence and/or resistance to treatment, responsible for significant morbidity. The study aimed at identifying prognostic factors of postsurgical outcome using data-driven classification of patients.

DESIGN

Retrospective observational study.

METHODS

Clinicopathological and radiological data of patients with PitNET treated via endoscopic endonasal surgery were collected. Tumour recurrence/progression and progression-free survival were assessed by classification tree analysis (CTA) and Kaplan-Meier curves, respectively. Histological subtype, cavernous/sphenoid sinus invasion, mitosis, Ki-67, p53, Trouillas' grading, degree of tumour exeresis and postsurgery disease activity were also evaluated.

RESULTS

A total of 1066 (466 gonadotroph, 287 somatotroph, 148 lactotroph, 157 corticotroph and 8 thyrotroph) tumours were included; 21.7% invaded the cavernous/sphenoid sinus. Based on Trouillas' classification, 64.3% were grade 1a, 14.2% 1b, 16.1% 2a, and 5.4% 2b; 18.3% had >2/10 HPF mitoses, 24.9% had Ki-67 ≥3%; 15.8% were positive for p53. Exeresis was radical in 81.2% of the cases. Median follow-up was 59.2 months. At last evaluation, 79.4% of the patients were cured; 20.6% had disease persistence, controlled by medical treatment in 18.3% of them. Disease recurrence/progression was recorded in 10.9% of the cases. CTA identified 5 distinct patient subgroups with different risk of disease recurrence/progression. Grade 2 of the Trouillas' grading, >2/10 HPF mitoses, Ki-67 ≥3%, p53 protein expression (P < .001), tumour invasion (P = .002) and ACTH-subtype (P = .003) were identified as risk factors of disease recurrence/progression.

CONCLUSIONS

The combined evaluation of Trouillas' grading, proliferation indexes and immunohistochemistry appears promising in the prediction of surgical outcome in PitNET.

摘要

目的

垂体神经内分泌肿瘤（PitNET）可能具有侵袭性，表现为局部侵犯、术后复发和/或治疗耐药，导致显著的发病率。本研究旨在使用数据驱动的患者分类来确定术后结果的预后因素。

设计

回顾性观察性研究。

方法

收集经内镜经鼻手术治疗的 PitNET 患者的临床病理和影像学数据。通过分类树分析（CTA）和 Kaplan-Meier 曲线分别评估肿瘤复发/进展和无进展生存期。还评估了组织学亚型、海绵窦/蝶窦侵犯、有丝分裂、Ki-67、p53、Trouillas 分级、肿瘤切除程度和术后疾病活动度。

结果

共纳入 1066 例（466 例促性腺激素瘤、287 例生长激素瘤、148 例催乳素瘤、157 例促皮质激素瘤和 8 例促甲状腺激素瘤）肿瘤；21.7%侵犯海绵窦/蝶窦。根据 Trouillas 分级，64.3%为 1a 级，14.2%为 1b 级，16.1%为 2a 级，5.4%为 2b 级；18.3%的有丝分裂数>2/10HPF，24.9%的 Ki-67≥3%；15.8%的 p53 阳性。81.2%的病例切除彻底。中位随访时间为 59.2 个月。最后一次评估时，79.4%的患者治愈；20.6%的患者疾病持续存在，其中 18.3%通过药物治疗得到控制。10.9%的病例记录到疾病复发/进展。CTA 确定了 5 个不同的患者亚组，具有不同的疾病复发/进展风险。Trouillas 分级 2 级、有丝分裂数>2/10HPF、Ki-67≥3%、p53 蛋白表达（P<.001）、肿瘤侵犯（P=.002）和 ACTH 亚型（P=.003）被确定为疾病复发/进展的危险因素。