Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City , Utah , USA.
School of Medicine, University of Utah, Salt Lake City , Utah , USA.
Neurosurgery. 2024 Oct 1;95(4):761-769. doi: 10.1227/neu.0000000000003042. Epub 2024 Jun 21.
Cushing disease (CD) affects mortality and quality of life along with limited long-term remission, underscoring the need to better identify recurrence risk. The identification of surgical or imaging predictors for CD remission after transsphenoidal surgery has yielded some inconsistent results and has been limited by single-center, single-surgeon, or meta-analyses studies. We sought to evaluate the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database of academic US pituitary centers to assess whether robust nonhormonal recurrence predictors could be elucidated.
Patients with treated CD from 2011 to 2023 were included. The perioperative and long-term characteristics of CD patients with and without recurrence were assessed using univariable and multivariable analyses.
Of 383 patients with CD from 26 surgeons achieving postoperative remission, 288 (75.2%) maintained remission at last follow-up while 95 (24.8%) showed recurrence (median time to recurrence 9.99 ± 1.34 years). Patients with recurrence required longer postoperative hospital stays (5 ± 3 vs 4 ± 2 days, P = .002), had larger average tumor volumes (1.76 ± 2.53 cm 3 vs 0.49 ± 1.17 cm 3 , P = .0001), and more often previously failed prior treatment (31.1% vs 14.9%, P = .001) mostly being prior surgery. Multivariable hazard prediction models for tumor recurrence found younger age (odds ratio [OR] = 0.95, P = .002) and Knosp grade of 0 (OR = 0.09, reference Knosp grade 4, P = .03) to be protective against recurrence. Comparison of Knosp grade 0 to 2 vs 3 to 4 showed that lower grades had reduced risk of recurrence (OR = 0.27, P = .04). Other factors such as length of stay, surgeon experience, prior tumor treatment, and Knosp grades 1, 2, or 3 failed to reach levels of statistical significance in multivariable analysis.
This multicenter study centers suggests that the strongest predictors of recurrence include tumor size/invasion and age. This insight can help with patient counseling and prognostication. Long-term follow-up is necessary for patients, and early treatment of small tumors may improve outcomes.
库欣病（CD）会影响死亡率和生活质量，且缓解时间有限，这突显了更好地识别复发风险的必要性。经蝶窦手术（TSS）后，对于 CD 缓解的手术或影像学预测因素的识别结果并不一致，且受到单中心、单外科医生或荟萃分析研究的限制。我们试图评估美国学术垂体中心的垂体腺瘤及相关疾病注册中心（RAPID）数据库，以评估是否可以明确可靠的非激素复发预测因素。
纳入了 2011 年至 2023 年间接受治疗的 CD 患者。使用单变量和多变量分析评估了有和无复发的 CD 患者的围手术期和长期特征。
在 26 位外科医生治疗的 383 例 CD 患者中，288 例（75.2%）在末次随访时仍处于缓解状态，95 例（24.8%）出现复发（复发中位时间 9.99±1.34 年）。复发患者的术后住院时间更长（5±3 天 vs 4±2 天，P=0.002），肿瘤平均体积更大（1.76±2.53cm3 vs 0.49±1.17cm3，P=0.0001），且更多患者既往治疗失败（31.1% vs 14.9%，P=0.001），主要为既往手术治疗。肿瘤复发的多变量风险预测模型发现，年龄较小（比值比[OR]为 0.95，P=0.002）和 Knosp 分级为 0（OR 为 0.09，参考 Knosp 分级为 4，P=0.03）是复发的保护因素。与 Knosp 分级 0-2 相比，Knosp 分级 3-4 显示复发风险降低（OR 为 0.27，P=0.04）。其他因素，如住院时间、外科医生经验、既往肿瘤治疗、Knosp 分级 1、2 或 3，在多变量分析中均未达到统计学意义。
这项多中心研究表明，复发的最强预测因素包括肿瘤大小/侵袭性和年龄。这一见解有助于患者咨询和预后判断。患者需要长期随访，早期治疗小肿瘤可能会改善结局。
