Department of Neurosurgery, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
Department of Radiology, VUB University Hospital of Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
BMC Endocr Disord. 2020 May 19;20(1):68. doi: 10.1186/s12902-020-0543-4.
Surgical resection of prolactinomas resistant to dopamine agonists is frequently incomplete due to fibrotic changes of the tumour under pharmacological therapy. In order to identify a subgroup of patients who may benefit from early surgery, we thought to investigate possible predictive factors of pharmacological resistance of prolactinomas to dopamine agonists.
We retrospectively analyzed a database of a Belgian tertiary reference center for patients with pituitary tumours from 2014 to 2016. The groups of interest were patients with dopamine agonist responsive and resistant prolactinomas. The possible predictive factors, including MRI findings, endocrinological parameters, response of tumour and patient factors for dopamine agonist resistance were investigated.
We included 69 patients of whom 52 were women (75,4%) and 17 were men (24,6%). Rate of dopamine agonist resistance was 15.9%. We identified four significant predictors of dopamine agonist resistance: male gender, a large tumour volume, prolonged time to prolactin normalization and presence of a cystic, hemorrhagic and/or necrotic component. In addition, symptoms due to mass effect, high baseline prolactin level and a high contrast capture on MRI are factors that can be taken into consideration.
We identified predictive factors for pharmacological resistance and developed a scoring system for patient specific prediction of resistance to dopamine agonists. This scoring system may have impact on the timing and decision of surgery in prolactinoma patients after further prospective evaluation.
由于药物治疗下肿瘤的纤维化改变，多巴胺受体激动剂耐药的催乳素瘤的手术切除常常不完整。为了确定可能从早期手术中获益的患者亚组，我们试图研究催乳素瘤对多巴胺受体激动剂药物耐药的可能预测因素。
我们回顾性分析了 2014 年至 2016 年比利时一家三级垂体肿瘤参考中心的患者数据库。感兴趣的组是多巴胺受体激动剂反应性和耐药性催乳素瘤患者。研究了可能的预测因素，包括 MRI 发现、内分泌参数、肿瘤和患者对多巴胺受体激动剂耐药的反应因素。
我们纳入了 69 名患者，其中 52 名女性（75.4%），17 名男性（24.6%）。多巴胺受体激动剂耐药率为 15.9%。我们确定了四个多巴胺受体激动剂耐药的显著预测因素：男性、肿瘤体积大、催乳素正常化时间延长以及存在囊性、出血性和/或坏死成分。此外，由于肿块效应引起的症状、高基线催乳素水平和 MRI 上的高对比摄取也是可以考虑的因素。
我们确定了药物耐药的预测因素，并为多巴胺受体激动剂耐药患者建立了一种针对患者的预测评分系统。在进一步的前瞻性评估后，该评分系统可能会对催乳素瘤患者的手术时机和决策产生影响。
