van Trigt Victoria R, Bakker Leontine E H, Pelsma Iris C M, Zandbergen Ingrid M, Jentus Maaia M, Kruit Mark C, Dekkers Olaf M, van Furth Wouter R, Verstegen Marco J T, Biermasz Nienke R
Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
J Clin Endocrinol Metab. 2025 May 19;110(6):e1833-e1844. doi: 10.1210/clinem/dgae652.
To evaluate patients with prolactinoma treated surgically in a time when elective prolactinoma surgery became routine in our center, using a comprehensive outcome set, focusing on preoperative assessments, surgical outcomes, and health-related quality of life (HR-QoL).
Cohort of consecutive patients with prolactinoma undergoing surgery between January 2021 and August 2023. Clinical data were collected during multidisciplinary team meetings/from medical records at distinct timepoints: (1) presurgery, (2) 2 weeks postsurgery, (3) 6 months postsurgery, and (4) follow-up (median, 15.0 [10.0-24.8 months]). HR-QoL was measured using the Leiden Bothers and Needs Pituitary questionnaire. Data were described for all patients, and patients undergoing elective total resection, with additional subgroups of (1) patients undergoing a high-probability first total resection and (2) reoperations aiming for total resection.
One hundred surgically treated patients with prolactinoma were included (72 female). Dopamine agonist intolerance was the most frequent indication (n = 68). The surgical goal (debulking/total resection) was achieved in 90% of patients. Long-term complications occurred in 4% of patients. Seventy-eight patients underwent an elective total resection, achieving remission in 91%. The subsets of preoperatively estimated high-probability-first total resections (n = 52) and reoperations (n = 9) achieved remission in 92% and 89%, respectively. Leiden Bothers and Needs Pituitary Total Bothers and Total Needs scores improved significantly after surgery (P < .001, Δ-3.4 [interquartile range, -14.4 to -0.9] and P = .006, Δ-1.8 [interquartile range, -11.9 to 1.3]), respectively.
High remission rates were achieved, improving HR-QoL, demonstrating (repeat) prolactinoma surgery is effective in an experienced pituitary center, as highlighted in the most recent guideline (2023).
在我们中心选择性泌乳素瘤手术成为常规手术的时期，使用一套综合的结果指标，重点关注术前评估、手术结果和健康相关生活质量（HR-QoL），对接受手术治疗的泌乳素瘤患者进行评估。
纳入2021年1月至2023年8月期间连续接受泌乳素瘤手术的患者队列。在多学科团队会议期间/在不同时间点从病历中收集临床数据：（1）术前，（2）术后2周，（3）术后6个月，以及（4）随访（中位数，15.0[10.0 - 24.8个月]）。使用莱顿兄弟与垂体需求问卷测量HR-QoL。描述了所有患者的数据，以及接受选择性全切除的患者，另外分为（1）接受高概率首次全切除的患者和（2）旨在全切除的再次手术患者亚组。
纳入100例接受手术治疗的泌乳素瘤患者（72例女性）。多巴胺激动剂不耐受是最常见的适应证（n = 68）。90%的患者实现了手术目标（减瘤/全切除）。4%的患者发生长期并发症。78例患者接受了选择性全切除，91%实现缓解。术前估计为高概率首次全切除的亚组（n = 52）和再次手术亚组（n = 9）分别有92%和89%实现缓解。术后莱顿兄弟与垂体需求总困扰和总需求评分均显著改善（P <.001，Δ - 3.4[四分位间距，- 14.4至 - 0.9]；P =.006，Δ - 1.8[四分位间距，- 11.9至1.3]）。
实现了高缓解率，改善了HR-QoL，表明（再次）泌乳素瘤手术在经验丰富的垂体中心是有效的，正如最新指南（2023年）所强调的那样。
