Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland.
Military Outpatient Clinic, Nowy Dwór Mazowiecki, Poland.
Front Endocrinol (Lausanne). 2020 Jul 7;11:439. doi: 10.3389/fendo.2020.00439. eCollection 2020.
Most patients with prolactinomas receive pharmacological treatment only, resulting in limited research on the predictors of successful prolactinoma surgery. In this study, we analyzed whether early postoperative serum prolactin concentrations and selected tumor characteristics could predict early, hormonal remission after removal of prolactinomas. We prospectively enrolled 48 consecutive patients with prolactinomas who underwent transsphenoidal resection performed by the same surgeon. Early remission, defined as a lack of hyperprolactinemia symptoms and normalization of serum prolactin concentration, was ascertained in all patients at 3 months. We evaluated the invasiveness of prolactinomas on the Knosp grading scale and measured serum prolactin concentrations on the first postoperative day. Routine immunohistochemical analysis, evaluation for plurihormonality, and assessment of the Ki-67 proliferation index (<3 or ≥3% of positive nuclei) were performed in all tumor samples. Of 48 patients, 38 (79%) achieved early biochemical remission at 3 months. Patients in early remission at 3 months had lower serum prolactin concentrations on the first postoperative day than patients with recurrent or persistent hyperprolactinemia ( < 0.001). Using univariate logistic regression, larger maximum tumor diameter ( = 0.014), higher Knosp grade ( < 0.001), and plurihormonality predicted remission at 3 months ( = 0.021). However, using multivariate stepwise logistic regression, only the Knosp grade remained significant ( < 0.001). Radiological assessment of prolactinoma invasiveness (Knosp grades) and early postoperative serum prolactin concentrations are important predictors of early remission following transsphenoidal prolactinoma resection.
大多数泌乳素瘤患者仅接受药物治疗，因此对泌乳素瘤手术成功的预测因素的研究有限。在这项研究中，我们分析了术后早期血清泌乳素浓度和选定的肿瘤特征是否可以预测泌乳素瘤切除后的早期激素缓解。我们前瞻性纳入了 48 例由同一位外科医生行经蝶窦切除术的泌乳素瘤患者。所有患者均在术后 3 个月时确定早期缓解，即缺乏高泌乳素血症症状和血清泌乳素浓度正常。我们采用 Knosp 分级量表评估泌乳素瘤的侵袭性，并在术后第 1 天测量血清泌乳素浓度。对所有肿瘤标本进行常规免疫组化分析、多激素评估以及 Ki-67 增殖指数（<3%或≥3%阳性核）评估。在 48 例患者中，有 38 例（79%）在术后 3 个月达到早期生化缓解。在术后 3 个月时达到早期缓解的患者，其术后第 1 天的血清泌乳素浓度低于复发或持续高泌乳素血症患者（<0.001）。使用单变量逻辑回归，最大肿瘤直径较大（=0.014）、Knosp 分级较高（<0.001）和多激素性预测 3 个月时缓解（=0.021）。然而，使用多变量逐步逻辑回归，仅 Knosp 分级仍然具有显著意义（<0.001）。泌乳素瘤侵袭性（Knosp 分级）的影像学评估和术后早期血清泌乳素浓度是经蝶窦泌乳素瘤切除术后早期缓解的重要预测因素。
