Ancil Sanish, Gupta Kirti, S Subin, Das Liza, Ahuja Chirag Kamal, Chhabra Rajesh, Dhandapani Sivashanmugam, Dutta Pinaki
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Surg Neurol Int. 2024 Aug 2;15:268. doi: 10.25259/SNI_1001_2023. eCollection 2024.
Acromegaly is a rare chronic endocrine disorder with variable biochemical remission rates from 40% to 85%. Hence, understanding the factors predicting biochemical cures helps in planning targeted and personalized treatment. We aimed to study the various clinico-radio-pathological predictors of outcomes in patients with pituitary neuroendocrine tumor (PitNET) who underwent transsphenoidal surgery (TSS) at 3 months follow-up.
Our cohort included 61 consecutive patients with acromegaly treated at an institute in northwest India between January 2019 and June 2021. The outcomes of TSS were assessed at the end of 3 months postoperatively as defined by Endocrine Society Guidelines 2014.
The mean age at diagnosis was 38 ± 12 years, with the majority being females (67.2%). The median tumor volume was 2376 mm with high insulin-like growth factor-1 levels (3.12 ± 1.76 times the upper reference limit). Forty-two patients (68.8%) had radiological evidence of cavernous sinus invasion. Overall, the biochemical remission rate at 3 months was 34.4%. Unlike preoperative Knosp grading, T2-hypointensity was not predictive of biochemical remission. The granularity of PitNET, as well as immunohistochemical (IHC) markers such as Ki-67 index somatostatin receptor subtype (SSTR2/5) and low-molecular-weight cytokeratin (CAM5.2) expression, failed to show any significant correlation with remission.
Overall, bulky tumors, higher hormone burden, and advanced Knosp grades translated to lower rates of biochemical remission in the present study cohort. Contrary to earlier studies, conventional IHC markers such as Ki-67, SSTR2/5, and CAM5.2 were not useful for predicting biochemical remission at 3 months.
肢端肥大症是一种罕见的慢性内分泌疾病，生化缓解率在40%至85%之间变化。因此，了解预测生化治愈的因素有助于规划有针对性的个性化治疗。我们旨在研究在3个月随访时接受经蝶窦手术（TSS）的垂体神经内分泌肿瘤（PitNET）患者预后的各种临床-放射-病理预测因素。
我们的队列包括2019年1月至2021年6月期间在印度西北部一家机构接受治疗的61例连续肢端肥大症患者。根据2014年内分泌学会指南，在术后3个月末评估TSS的结果。
诊断时的平均年龄为38±12岁，大多数为女性（67.2%）。肿瘤体积中位数为2376立方毫米，胰岛素样生长因子-1水平较高（是参考上限的3.12±1.76倍）。42例患者（68.8%）有海绵窦侵袭的影像学证据。总体而言，3个月时的生化缓解率为34.4%。与术前Knosp分级不同，T2低信号不能预测生化缓解。PitNET的颗粒度以及免疫组化（IHC）标志物，如Ki-67指数、生长抑素受体亚型（SSTR2/5）和低分子量细胞角蛋白（CAM5.2）表达，与缓解均无显著相关性。
总体而言，在本研究队列中，肿瘤体积大、激素负荷高和Knosp分级高导致生化缓解率较低。与早期研究相反，常规IHC标志物如Ki-67、SSTR2/5和CAM5.2对预测3个月时的生化缓解无用。
