Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World J Surg Oncol. 2023 Mar 1;21(1):71. doi: 10.1186/s12957-023-02958-2.
Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNETs). Excision of the tumor may have positive or negative effects on pituitary endocrine function, and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function.
A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary tumor resection and were published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE.
Sixty-eight studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95% CI, 0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95% CI, 0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0 to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery (OR = 0.712; 95% CI, 0.527-0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95% CI, 0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95% CI, 0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times the risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant.
In patients with somatotroph tumors after undergoing endoscopic surgery, the risk of dysfunction and pituitary insufficiency tend to increase, while preoperative thyroid insufficiency, gonadal insufficiency, and hyperprolactinemia will be partially relieved.
目前，内镜经蝶窦手术是治疗垂体神经内分泌肿瘤（PitNETs）的主要方法。肿瘤的切除可能对垂体内分泌功能产生积极或消极的影响，而术后生长激素腺瘤的垂体功能是一个特别关注的问题。本研究旨在对内镜经蝶窦生长激素腺瘤切除术对垂体功能的影响进行荟萃分析。
系统检索了 1992 年至 2022 年期间在 PubMed、Cochrane 和 Ovid MEDLINE 上发表的评估内镜经蝶窦垂体肿瘤切除前后垂体靶腺功能的文章，并进行了文献筛选。
共纳入 68 项研究，其中包括 4524 例生长激素腺瘤的生化缓解率。根据 2000 年共识，内镜经蝶窦手术后的生化缓解率为 66.4%（95%CI，0.622-0.703；P=0.000），根据 2010 年共识，生化缓解率为 56.2%（95%CI，0.503-0.620；P=0.041），根据研究者的定义，生化缓解率范围为 30.0%至 91.7%。内镜切除后，肾上腺轴功能障碍略高于术前，但差异无统计学意义。甲状腺功能减退的风险比术前高 0.712 倍（OR=0.712；95%CI，0.527-0.961；P=0.027）。性腺功能减退的风险比术前高 0.541 倍（OR=0.541；95%CI，0.393-0.746；P=0.000）。高泌乳素血症的风险比术前高 0.131 倍（OR=0.131；95%CI，0.022-0.783；P=0.026）。生长激素腺瘤内镜切除后，垂体功能不全的发生率是术前的 1.344 倍，但差异无统计学意义。
生长激素腺瘤患者术后，功能障碍和垂体功能不全的风险倾向于增加，而术前甲状腺功能减退、性腺功能减退和高泌乳素血症会得到部分缓解。
