Hong Sukwoo, Atkinson John L, Erickson Dana, Kizilbash Sani H, Little Jason T, Routman David M, Van Gompel Jamie J
Departments of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Departments of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2023 Apr;172:e684-e694. doi: 10.1016/j.wneu.2023.02.002. Epub 2023 Feb 9.
Metastasis to the pituitary gland is uncommon. With life expectancy after cancer diagnosis improving, we sought to understand the effects of treating pituitary metastasis in the modern era of advanced cancer treatment.
Patients who had been diagnosed with, and treated for, pituitary metastasis from 2000 to 2021 were retrospectively analyzed.
A total of 48 patients were identified, of whom 23 (48%) were women. The most common primary cancer was the lung (n = 23; 48%), followed by the breast (n = 9; 19%). Of the 48 patients, 29 (60%) had had hypopituitarism and 12 (25%), visual field deficits. Twenty-seven patients (56%) had had solitary pituitary metastasis, with no evidence of other intracranial metastatic lesions. Of the 48 patients, 14 (29%) had undergone surgery and 20 (42%) had undergone standalone radiation therapy (preceded by biopsy for 3). After surgery and/or radiation therapy, the visual field deficits had improved in 6 patients, hypopituitarism had improved in 4 patients, and hypopituitarism had occurred in 3 patients. The median overall survival (OS) was 12 months (interquartile range, 3.0-28 months). Multivariate analysis showed nonsolitary pituitary metastasis (hazard ratio, 2.8; 95% confidence interval, 1.5-5.5; P = 0.0021) and no surgery or radiation therapy (hazard ratio, 2.08; 95% confidence interval, 1.04-4.15; P = 0.038) were associated with OS. For those with solitary pituitary metastasis, the patients who had undergone surgery and/or radiation therapy had had better 1-year OS than patients who had not received either (P = 0.03). In contrast, for patients with nonsolitary pituitary metastasis, those who had undergone standalone radiation therapy had had better 1-year OS than the patients who had not received either (P = 0.03).
In the selected population, metastasis-directed therapy was associated with improved OS. Either correct patient selection for additional therapy or surgery and/or radiation therapy directly benefited patients' OS.
垂体转移并不常见。随着癌症诊断后预期寿命的提高，我们试图了解在晚期癌症治疗的现代时代治疗垂体转移的效果。
对2000年至2021年期间被诊断并接受垂体转移治疗的患者进行回顾性分析。
共确定48例患者，其中23例（48%）为女性。最常见的原发癌是肺癌（n = 23；48%），其次是乳腺癌（n = 9；19%）。48例患者中，29例（60%）有垂体功能减退，12例（25%）有视野缺损。27例患者（56%）有孤立性垂体转移，无其他颅内转移病灶的证据。48例患者中，14例（29%）接受了手术，20例（42%）接受了单纯放疗（3例在放疗前进行了活检）。手术和/或放疗后，6例患者的视野缺损有所改善，4例患者的垂体功能减退有所改善，3例患者出现了垂体功能减退。中位总生存期（OS）为12个月（四分位间距，3.0 - 28个月）。多变量分析显示，非孤立性垂体转移（风险比，2.8；95%置信区间，1.5 - 5.5；P = 0.0021）以及未进行手术或放疗（风险比，2.08；95%置信区间，1.04 - 4.15；P = 0.038）与总生存期相关。对于有孤立性垂体转移的患者，接受手术和/或放疗的患者1年总生存期优于未接受任何一种治疗的患者（P = 0.03）。相比之下，对于有非孤立性垂体转移的患者，接受单纯放疗的患者1年总生存期优于未接受任何一种治疗的患者（P = 0.03）。
在选定人群中，针对转移的治疗与总生存期改善相关。正确选择患者进行额外治疗或手术和/或放疗直接有益于患者的总生存期。
