Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
Oper Neurosurg (Hagerstown). 2023 Apr 1;24(4):460-467. doi: 10.1227/ons.0000000000000560. Epub 2022 Dec 19.
Cushing disease represents a challenge for neurosurgeons, with high recurrence rates reported. Characteristics associated with remission are incompletely understood; thus, an intraoperative predictor for outcome would be valuable for assessing resection of adrenocorticotropic hormone (ACTH) secreting tissue.
To evaluate whether intraoperative ACTH measurement could predict outcome after surgery for Cushing disease.
Retrospective cohort study of 55 consecutive encounters with Cushing disease who had peripheral plasma ACTH levels measured intraoperatively before, during, and after tumor resection. The primary outcome measure was remission, defined by either 2 negative 24-hour urine free cortisol or 2 negative midnight salivary cortisol measurements. A logistic regression machine learning model was generated using recursive feature elimination.
Fifty-five operative encounters, comprising 49 unique patients, had a mean follow-up of 2.73 years (±2.11 years) and a median follow-up of 2.07 years. Remission was achieved in 69.1% (n = 38) of all operations and in 78.0% (n = 32) of those without cavernous sinus invasion. The final ACTH level measured intraoperatively correctly predicted outcome (area under the curve = 0.766; P value = .002). The odds ratio of remission in patients with the lowest quartile vs highest quartile final intraoperative ACTH was 23.4 ( P value = .002). Logistic regression machine learning model resulted in incorporating postoperative day 1 morning cortisol, final intraoperative ACTH that predicted outcome with an average area under the curve of 0.80 ( P = .0027).
Intraoperative ACTH may predict outcome after surgery in Cushing disease; furthermore, investigation is warranted.
库欣病对神经外科医生来说是一个挑战，据报道其复发率较高。与缓解相关的特征尚未完全理解；因此，对于评估促肾上腺皮质激素（ACTH）分泌组织的切除，术中的预测指标将是有价值的。
评估术中 ACTH 测量是否可以预测库欣病手术后的结果。
对 55 例连续的库欣病患者进行回顾性队列研究，这些患者在肿瘤切除前、切除中和切除后进行外周血浆 ACTH 水平的术中测量。主要结局指标是缓解，定义为 2 次 24 小时尿游离皮质醇或 2 次午夜唾液皮质醇检测均为阴性。使用递归特征消除生成逻辑回归机器学习模型。
55 次手术，包含 49 例患者，平均随访 2.73 年（±2.11 年），中位数随访 2.07 年。所有手术中缓解率为 69.1%（n = 38），无海绵窦侵犯者为 78.0%（n = 32）。术中测量的最终 ACTH 水平正确预测了结果（曲线下面积=0.766；P 值=0.002）。最低四分位术中最终 ACTH 与最高四分位患者的缓解率之比为 23.4（P 值=0.002）。逻辑回归机器学习模型纳入术后第 1 天早晨皮质醇和预测结果的最终术中 ACTH，平均曲线下面积为 0.80（P=0.0027）。
术中 ACTH 可能预测库欣病手术后的结果；因此，值得进一步研究。
