Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
Department of Neuropathology, Beijing Neurosurgical Institute, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
Pituitary. 2021 Oct;24(5):754-767. doi: 10.1007/s11102-021-01152-5. Epub 2021 May 12.
Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis.
We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression.
In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008-8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015-12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240-15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335-17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020-9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486-309.595; p = 0.001).
Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.
垂体细胞瘤的术前诊断较为困难，其治疗和预后因素仍不明确。本研究旨在阐明垂体细胞瘤的影像学特征，评估影响肿瘤进展的危险因素，并在此基础上提出最佳治疗方案。
我们回顾性分析了在我院经病理证实的 22 例垂体细胞瘤患者的临床资料，同时纳入了 93 例文献中的垂体细胞瘤病例。对 115 例患者的个体数据进行分析，以评估影响垂体细胞瘤进展的不良因素。
在全切除（GTR）的 61 例患者中，有 3 例（4.9%）复发；非 GTR 的 54 例患者中，有 19 例（35.2%）进展。单因素和多因素 Cox 回归分析证实，男性（HR 2.855，95%CI 1.008-8.089；p=0.048）、TS（经蝶窦手术；HR 3.559，95%CI 1.015-12.476；p=0.047）和非 GTR（HR 4.388，95%CI 1.240-15.521；p=0.022）是垂体细胞瘤进展的独立不良因素。多因素 logistic 回归模型证实，肿瘤直径≥1.85cm（OR 4.859，95%CI 1.335-17.691；p=0.016）是 GTR 的独立不良因素。与 TS 相比，OT（开颅手术）更有可能发生术后并发症（OR 3.185，95%CI 1.020-9.944；p=0.046），尤其是视力恶化（OR 37.267，95%CI 4.486-309.595；p=0.001）。
根据我们的研究结果，GTR 被推荐为垂体细胞瘤的最佳治疗方法。然而，为了避免重要结构受损，部分切除也是可以接受的。此后，建议对 Ki-67 指数较高的男性患者进行辅助放疗，对其余患者进行密切随访。当肿瘤复发或进展时，建议尽可能再次手术切除病灶。如果仍然无法进行 GTR，则建议对残留肿瘤进行术后放疗。
