Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Endocrine. 2022 Jan;75(1):219-227. doi: 10.1007/s12020-021-02848-1. Epub 2021 Aug 20.
Transsphenoidal surgery (TSS) is the first-line treatment for patients with Cushing's disease (CD). However, the reported remission rates of patients who received TSS vary widely between different studies, and the predictors of surgical outcomes remain controversial. The present study analyzed the early outcome of TSS in a large population of patients with CD at a single center, and identified potential predictors of initial remission of TSS in patients with CD.
The clinical features and surgical outcomes of CD patients who underwent TSS between 1988 and 2018 at Peking Union Medical College Hospital (PUMCH) were collected and analyzed from their medical records.
Of the 1604 CD patients who underwent TSS at PUMCH between February 1988 and October 2018, 1106 patients had complete medical data and pathological results. After surgery, the overall postoperative initial remission rate was 72.5, and 27.5% of patients maintained persistent hypercortisolism. The initial remission rate of patients with preoperative noninvasive adenoma based on MRI (77.1%), intraoperative noninvasiveness (72.5%), microadenoma (74.3%), pathological confirmation (76.4%), and first TSS (73.9%) was significantly higher than that in patients with preoperative invasive adenoma (53.0%), intraoperative invasiveness (60.7%), macroadenomas (65.9%), pathologically negative (49.7%), and repeat TSS (56.0%), respectively (all P < 0.05). The initial remission rate in patients with pseudocapsule-based extracapsular resection (88.1%), MRI-visible adenoma (74.2%) was higher than that in patients without pseudocapsule-based extracapsular resection (77.1%), and with MRI-negative results (64.5%), respectively, but did not reach statistical significance (All P > 0.05). Striking, there was no significant differences in initial remission rates between patients who underwent selective adenomectomy and enlarged adenomectomy (P > 0.05). Whereas, the initial remission rates in patients who underwent partial hypophysectomy only was 51.0%, which was much lower than that in patients underwent selective adenomectomy and enlarged adenomectomy (P < 0.05).
The TSS is a safe and effective procedure for the treatment of CD. Whereas, preoperative invasiveness based on MRI, intraoperative invasiveness, macroadenomas pathologically negative, and repeat TSS are related to lower initial remission rates.
经蝶窦手术（TSS）是治疗库欣病（CD）患者的一线治疗方法。然而，不同研究报道的 TSS 患者缓解率差异很大，手术结果的预测因素仍存在争议。本研究分析了单中心大量 CD 患者 TSS 的早期结果，并确定了 CD 患者 TSS 初始缓解的潜在预测因素。
收集并分析了 1988 年 2 月至 2018 年 10 月期间在北京协和医学院医院（PUMCH）接受 TSS 的 CD 患者的临床特征和手术结果，并从他们的病历中进行分析。
在 1988 年 2 月至 2018 年 10 月期间，共有 1604 例 CD 患者在北京协和医学院医院接受 TSS 治疗，其中 1106 例患者有完整的医疗数据和病理结果。手术后，总的术后初始缓解率为 72.5%，27.5%的患者持续存在皮质醇增多症。术前 MRI 显示非侵袭性腺瘤（77.1%）、术中非侵袭性（72.5%）、微腺瘤（74.3%）、病理证实（76.4%）和初次 TSS（73.9%）的患者初始缓解率明显高于术前侵袭性腺瘤（53.0%）、术中侵袭性（60.7%）、大腺瘤（65.9%）、病理阴性（49.7%）和重复 TSS（56.0%）的患者（均 P<0.05）。基于假包膜的囊外切除（88.1%）、MRI 可见腺瘤（74.2%）的患者初始缓解率高于无假包膜的囊外切除（77.1%）和 MRI 阴性结果（64.5%）的患者，但差异无统计学意义（均 P>0.05）。值得注意的是，选择性腺瘤切除术和扩大腺瘤切除术患者的初始缓解率之间没有显著差异（P>0.05）。而仅行部分垂体切除术的患者初始缓解率为 51.0%，明显低于选择性腺瘤切除术和扩大腺瘤切除术患者（P<0.05）。
TSS 是治疗 CD 的一种安全有效的方法。然而，术前基于 MRI 的侵袭性、术中侵袭性、大腺瘤病理阴性和重复 TSS 与较低的初始缓解率相关。
