Rubino Franco, Martinez-Perez Rafael, Vieira Samuel, Voscoboinik Daniel Seclen, Mural Miguel, Orr Anna J, Hardesty Douglas A, Carrau Ricardo L, Prevedello Daniel M
Department of Neurological Surgery, Hospital Nacional Posadas, Buenos Aires, Argentina.
Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, N-1049 Doan Hall, Columbus, OH, 43210, USA.
Pituitary. 2020 Dec;23(6):721-732. doi: 10.1007/s11102-020-01068-6.
Granular cell tumors (GCT) are highly vascularized and adherent to adjacent structures, and so, complete resection represents a challenge. Adjuvant therapy decisions for residual GCTs currently relies on individual clinician decisions due to a paucity of systematic literature data. We present a comprehensive analysis about the impact of adjuvant therapy in reported cases of patients with incomplete GCT resection.
One database (PubMed) and crossed references were queried for GCT with incomplete resection or biopsy from 1962 to 2020. Literature review was performed according to the PRISMA guidelines. Also, two patients with residual GCT from our institutions are added to the analysis. Data regarding clinical presentation, surgical approach, use of adjuvant therapy, Ki-67 labeling, and follow up assessments were extracted and analyzed from selected publications.
Thirty-three studies met the predetermined inclusion criteria and 53 patients were selected (including our two reported cases). The median of age was 49 [IQR, 39-60 years], with a slight male predominance (1.2:1). Among the surgical procedures, seven (13%) were biopsies alone. Adjuvant therapy was used in 18 patients (radiotherapy, 94.5%; chemotherapy, 5.5%) but there is no statistical correlation with adjuvant therapy and the progression of the remnant tumor (p = 0.33). Our institutions' patients did not receive adjuvant therapy and did not show tumor progression on MRI.
Our systematic literature review suggests there is a limited role for chemo and/or radiotherapy in the management of incomplete GCT resection. It may be reasonable recommending close clinical follow up in patients with incomplete resection.
颗粒细胞瘤（GCT）血管高度丰富且与相邻结构粘连，因此完整切除具有挑战性。由于缺乏系统的文献数据，目前对于残留GCT的辅助治疗决策依赖于临床医生的个人判断。我们对已报道的GCT切除不完全患者病例中辅助治疗的影响进行了全面分析。
查询一个数据库（PubMed）及其交叉参考文献，以获取1962年至2020年GCT切除不完全或活检的病例。根据PRISMA指南进行文献综述。此外，将我们机构的两名残留GCT患者纳入分析。从选定的出版物中提取并分析有关临床表现、手术方法、辅助治疗的使用、Ki-67标记和随访评估的数据。
33项研究符合预定的纳入标准，共选择了53例患者（包括我们报告的2例病例）。年龄中位数为49岁[四分位间距，39 - 60岁]，男性略占优势（1.2:1）。在手术操作中，7例（13%）仅为活检。18例患者接受了辅助治疗（放疗，94.5%；化疗，5.5%），但辅助治疗与残留肿瘤进展之间无统计学相关性（p = 0.33）。我们机构的患者未接受辅助治疗，MRI检查也未显示肿瘤进展。
我们的系统文献综述表明，化疗和/或放疗在GCT切除不完全的治疗中作用有限。对于切除不完全的患者，建议进行密切的临床随访可能是合理的。
