Lutsenko A S, Belaya Zh E, Przhiyalkovskaya E G, Lapshina A M, Nikitin A G, Azizyan V N, Ivaschenko O V, Grigoriev A Yu, Melnichenko G A
Endocrinology Research Centre, Moscow.
Endocrinology Research Centre.
Probl Endokrinol (Mosk). 2022 Nov 24;68(6):67-75. doi: 10.14341/probl13192.
Neurosurgery is the most effective treatment for acromegaly. As most of the patients present with macroadenomas, surgical treatment is not always successful, even with the expert level of a neurosurgeon. Assessment of the postoperative remission rates in acromegaly preoperative predictors of treatment efficacy is an urgent task of modern research.
To assess the short-term and long-term remission of acromegaly after endoscopic transnasal adenomectomy in a tertiary medical center and assess preoperative predictors of the treatment effectiveness.
A single-center, prospective, uncontrolled study was conducted. We included patients with active acromegaly who did not receive medical therapy with somatostatin analogues and were referred for endoscopic transsphenoidal adenomectomy. Plasma miRNA expression was assessed by quantitative reverse transcription PCR. Postoperative samples of adenomas were sent for study, with the determination of the immunohistochemical staining for somatostatin receptors 2 and 5 subtypes and morphology was performed on postoperative adenoma samples.
The study included 44 patients: 32.8% men, median age 47.0 [34.0; 55.0], IGF-1 744.75 ng/ml [548.83;889.85], growth hormone 9.5 ng/ml [4.94; 17.07]. Tumor volume 832 mm3 [419.25; 2532.38]. Early postoperative remission was achieved in 35 patients (79.5%). Patients who achieved short-term remission had higher IGF-1 and basal growth hormone levels. Median follow-up was 19.0 months [12.5;29.0]. Long-term remission was achieved in 61.4% (27 patients), no remission in 9 (20.5%), recurrency in 2 patients (4.5%), 6 patients were to follow-up (13.6%). In patients with long-term remission, we observed lower growth hormone and IGF-1 levels. No differences in miRNA expression was observesd. The predictive value of basal GH before surgery for long-term remission was assessed: area under the curve 0.811 (95% CI: 0.649; 0.973). A cut-off value of 15.55 ng/mL corresponded to a sensitivity of 70.0% (34.8%; 93.3%), a specificity of 85.7% (67.3%; 96.0%), an accuracy of 81.6% (65 .7%; 92.3%), PPV 63.6% (39.3%; 82.5%), NPV 88.9% (75.4%; 95.4%).
Rates of short-term and long-term remission after endoscopic transsphenoidal adenomectomy in our cohort is 79,5% и 61,4%, respectively, and is comparable with literature data for expert pituitary centers. Preoperative GH shows potential value in predicting the long-term remission of acromegaly, but further studies in a larger sample are needed to obtain more accurate cut-off values.
神经外科手术是肢端肥大症最有效的治疗方法。由于大多数患者表现为大腺瘤，即使在神经外科专家水平的操作下，手术治疗也并非总是成功。评估肢端肥大症术后缓解率及治疗效果的术前预测指标是现代研究的一项紧迫任务。
评估在三级医疗中心经鼻内镜腺瘤切除术后肢端肥大症的短期和长期缓解情况，并评估治疗效果的术前预测指标。
进行了一项单中心、前瞻性、非对照研究。纳入未接受生长抑素类似物药物治疗且被转诊接受经蝶窦内镜腺瘤切除术的活动性肢端肥大症患者。通过定量逆转录聚合酶链反应评估血浆微小RNA（miRNA）表达。将腺瘤术后样本送检，测定生长抑素受体2和5亚型的免疫组化染色，并对术后腺瘤样本进行形态学检查。
该研究纳入44例患者：男性占32.8%，中位年龄47.0岁[34.0；55.0]，胰岛素样生长因子-1（IGF-1）为744.75 ng/ml[548.83；889.85]，生长激素为9.5 ng/ml[4.94；17.07]。肿瘤体积为832 mm³[419.25；2532.38]。35例患者（79.5%）实现了术后早期缓解。实现短期缓解的患者IGF-1和基础生长激素水平较高。中位随访时间为19.0个月[12.5；29.0]。27例患者（61.4%）实现长期缓解，9例（20.5%）未缓解，2例（4.5%）复发，有6例患者（13.6%）有待随访。在长期缓解的患者中，观察到生长激素和IGF-1水平较低。未观察到miRNA表达存在差异。评估术前基础生长激素对长期缓解的预测价值：曲线下面积为0.811（95%置信区间：0.649；0.973）。截断值为15.55 ng/mL时，灵敏度为70.0%（34.8%；93.3%），特异性为85.7%（67.3%；96.0%），准确度为81.6%（65.7%；92.3%），阳性预测值为63.6%（39.3%；82.5%），阴性预测值为88.9%（75.4%；95.4%）。
在我们这个队列中经蝶窦内镜腺瘤切除术后的短期和长期缓解率分别为79.5%和61.4%，与垂体专家中心的文献数据相当。术前生长激素在预测肢端肥大症的长期缓解方面显示出潜在价值，但需要在更大样本中进行进一步研究以获得更准确的截断值。
