Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China.
Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
J Neurooncol. 2021 Jan;151(2):313-324. doi: 10.1007/s11060-020-03669-4. Epub 2021 Jan 4.
Acromegaly is a rare neuroendocrine condition that can lead to significant morbidity. Despite China's vast population size, studies on acromegaly remain sparse. This study aimed to investigate the clinical characteristics and predictors of biochemical remission after surgery for acromegaly using the China Acromegaly Patient Association (CAPA) database.
A retrospective nationwide study was conducted using patient-reported data from CAPA database between 1998 and 2018. The principal component analysis (PCA) and logistic regression analysis were employed to determine independent predictors of biochemical remission at 3 months in patients after surgery.
Of the 546 surgical cases (mean age: 36.8 years; 59.5% females), macroadenomas and invasive tumors (Knosp score 3-4) were 83.9% and 64.1%, respectively. Ninety-five percent of patients were treated with endonasal surgery and 36.8% exhibited biochemical remission at 3-months postoperatively. The following independent predictors of biochemical remission were identified: preoperative growth hormone (GH) levels between 12 and 28 μg/L [odds ratio (OR) = 0.58; 95% confidence interval (CI), 0.37-0.92; p = 0.021], preoperative GH levels > 28 μg/L (OR = 0.55; 95% CI, 0.34-0.88; p = 0.013), macroadenoma (OR = 0.56; 95% CI, 0.32-0.96; p = 0.034), giant adenomas (OR = 0.14; 95% CI, 0.05-0.38; p < 0.001), Knosp score 3-4 (OR = 0.37; 95% CI, 0.24-0.57; p < 0.001), and preoperative medication usage (OR = 2.32; 95% CI, 1.46-3.70; p < 0.001).
In this nationwide study spanning over two decades, we highlight that higher preoperative GH levels, large tumor size, and greater extent of tumor invasiveness are associated with a lower likelihood of biochemical remission at 3-months after surgery, while preoperative medical therapy increases the chance of remission.
肢端肥大症是一种罕见的神经内分泌疾病，可导致严重的发病率。尽管中国人口众多，但肢端肥大症的研究仍然很少。本研究旨在使用中国肢端肥大症患者协会（CAPA）数据库调查肢端肥大症患者手术后生化缓解的临床特征和预测因素。
使用 CAPA 数据库中 1998 年至 2018 年期间的患者报告数据进行回顾性全国性研究。采用主成分分析（PCA）和逻辑回归分析确定术后 3 个月患者生化缓解的独立预测因素。
在 546 例手术病例中（平均年龄：36.8 岁；59.5%为女性），大腺瘤和侵袭性肿瘤（Knosp 评分 3-4）分别为 83.9%和 64.1%。95%的患者接受了经鼻手术，术后 3 个月有 36.8%的患者生化缓解。确定了生化缓解的以下独立预测因素：术前生长激素（GH）水平在 12 至 28μg/L 之间[比值比（OR）=0.58；95%置信区间（CI），0.37-0.92；p=0.021]，术前 GH 水平>28μg/L（OR=0.55；95%CI，0.34-0.88；p=0.013），大腺瘤（OR=0.56；95%CI，0.32-0.96；p=0.034），巨大腺瘤（OR=0.14；95%CI，0.05-0.38；p<0.001），Knosp 评分 3-4（OR=0.37；95%CI，0.24-0.57；p<0.001）和术前药物治疗（OR=2.32；95%CI，1.46-3.70；p<0.001）。
在这项跨越 20 多年的全国性研究中，我们强调术前较高的 GH 水平、较大的肿瘤大小和更大程度的肿瘤侵袭性与术后 3 个月生化缓解的可能性降低相关，而术前药物治疗增加了缓解的机会。
