Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Pituitary. 2024 Apr;27(2):204-212. doi: 10.1007/s11102-024-01382-3. Epub 2024 Feb 12.
Pituitary adenomas are the most common tumor of the pituitary gland and comprise nearly 15% of all intracranial masses. These tumors are stratified into functional or silent categories based on their pattern of hormone expression and secretion. Preliminary evidence supports differential clinical outcomes between some functional pituitary adenoma (FPA) subtypes and silent pituitary adenoma (SPA) subtypes.
We collected and analyzed the medical records of all patients undergoing resection of SPAs or FPAs from a single high-volume neurosurgeon between 2007 and 2018 at Brigham and Women's Hospital. Descriptive statistics and the Mantel-Cox log-rank test were used to identify differences in outcomes between these cohorts, and multivariate logistic regression was used to identify predictors of radiographic recurrence for SPAs.
Our cohort included 88 SPAs and 200 FPAs. The majority of patients in both cohorts were female (48.9% of SPAs and 63.5% of FPAs). SPAs were larger in median diameter than FPAs (2.1 cm vs. 1.2 cm, p < 0.001). The most frequent subtypes of SPA were gonadotrophs (55.7%) and corticotrophs (30.7%). Gross total resection (GTR) was achieved in 70.1% of SPA resections and 86.0% of FPA resections (p < 0.001). SPAs had a higher likelihood of recurring (hazard ratio [HR] 3.2, 95% confidence interval [95%CI] 1.6-7.2) and a higher likelihood of requiring retreatment for recurrence (HR 2.5; 95%CI 1.0-6.1). Subset analyses revealed that recurrence and retreatment were more both likely for subtotally resected SPAs than subtotally resected FPAs, but this pattern was not observed in SPAs and FPAs after GTR. Among SPAs, recurrence was associated with STR (odds ratio [OR] 9.3; 95%CI 1.4-64.0) and younger age (OR 0.92 per year; 95%CI 0.88-0.98) in multivariable analysis. Of SPAs that recurred, 12 of 19 (63.2%) were retreated with repeat surgery (n = 11) or radiosurgery (n = 1), while the remainder were observed (n = 7).There were similar rates of recurrence across different SPA subtypes.
Patients undergoing resection of SPAs should be closely monitored for disease recurrence through more frequent clinical follow-up and diagnostic imaging than other adenomas, particularly among patients with STR and younger patients. Several patients can be observed after radiographic recurrence, and the decision to retreat should be individualized. Longitudinal clinical follow-up of SPAs, including an assessment of symptoms, endocrine function, and imaging remains critical.
垂体腺瘤是最常见的垂体肿瘤，约占所有颅内肿块的 15%。这些肿瘤根据其激素表达和分泌模式分为功能性或无功能性类别。初步证据支持某些功能性垂体腺瘤 (FPA) 亚型和无功能性垂体腺瘤 (SPA) 亚型之间存在不同的临床结果。
我们收集并分析了 2007 年至 2018 年间在布莱根妇女医院由同一位高容量神经外科医生切除的所有 SPA 或 FPA 患者的病历。描述性统计和 Mantel-Cox 对数秩检验用于识别这些队列之间结果的差异，多变量逻辑回归用于识别 SPA 影像学复发的预测因素。
我们的队列包括 88 例 SPA 和 200 例 FPA。两个队列中的大多数患者均为女性（SPA 为 48.9%，FPA 为 63.5%）。SPA 的中位直径大于 FPA（2.1cm 比 1.2cm，p<0.001）。最常见的 SPA 亚型是促性腺激素瘤（55.7%）和促皮质激素瘤（30.7%）。SPA 切除的 GTR 率为 70.1%，FPA 切除的 GTR 率为 86.0%（p<0.001）。SPA 更有可能复发（风险比 [HR] 3.2，95%置信区间 [95%CI] 1.6-7.2），并且更有可能因复发而需要再次治疗（HR 2.5；95%CI 1.0-6.1）。亚组分析显示，与部分切除的 FPA 相比，部分切除的 SPA 更有可能复发和需要再次治疗，但在 GTR 后的 SPA 和 FPA 中未观察到这种模式。在 SPA 中，复发与次全切除（优势比 [OR] 9.3；95%CI 1.4-64.0）和年龄较小（OR 每年 0.92；95%CI 0.88-0.98）相关在多变量分析中。在复发的 SPA 中，19 例中有 12 例（63.2%）因 STR 接受了再次手术（n=11）或放射手术（n=1）治疗，其余病例则进行了观察（n=7）。不同 SPA 亚型的复发率相似。
与其他腺瘤相比，接受 SPA 切除术的患者应通过更频繁的临床随访和诊断性影像学检查密切监测疾病复发，尤其是在 STR 和年轻患者中。在影像学复发后，有几个患者可以进行观察，再次治疗的决定应该个体化。对 SPA 的长期临床随访，包括对症状、内分泌功能和影像学的评估仍然至关重要。
