Toma Iustin Daniel, Niculescu Dan Alexandru, Găloiu Simona Andreea, Trifănescu Raluca Alexandra, Poiană Cătălina
Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
First Endocrinology Department, C. I. Parhon National Institute of Endocrinology, Bucharest, Romania.
Endocrine. 2025 Feb;87(2):782-787. doi: 10.1007/s12020-024-04073-y. Epub 2024 Oct 19.
Mortality in pituitary adenomas (PAs) has been extensively compared to general population. However, direct comparisons between PA subtypes are scarce. We aimed to compare mortality in various subtypes of PA (acromegaly, Cushing's disease (CD), macroprolactinomas and non-functioning pituitary macroadenomas (MacroNFPA)), within a single referral center.
We retrospectively analyzed mortality and survival time in all 962 PAs admitted in our department between 2011 and 2023: acromegaly (n = 306), CD (n = 69), macroprolactinoma (n = 168) and MacroNFPA (n = 419).
Median follow-up was 10.2 (5.2, 15.2) years. The overall survival probability was 90.9% and 78.1% after 10 and 20 years respectively with age at diagnosis as the only significant predictor. There were no significant differences in survival probability between various PA subtypes in the whole cohort. In patients over 45 years of age at diagnosis there was a significant difference in survival probability between the four groups (p = 0.01) in the first 15 years of follow-up. In head-to-head comparisons CD had a significantly higher mortality risk than patients with acromegaly (HR 3.38 [CI 95% 1.07 to 10.60]) even after adjusting for age and sex.
Patients diagnosed with CD after 45 years of age have a significantly lower survival probability than other PA subtypes in the first 15 years of follow-up. All other PA subtypes had a similar survival probability after adjusting for age and sex. Due to advances in medical treatment of hormone secreting tumors, mortality in patients with PAs might increasingly depend more on tumor mass than on hormonal hypersecretion.
垂体腺瘤（PA）的死亡率已与普通人群进行了广泛比较。然而，PA各亚型之间的直接比较却很少。我们旨在在单一转诊中心比较不同亚型PA（肢端肥大症、库欣病（CD）、大泌乳素瘤和无功能垂体大腺瘤（MacroNFPA））的死亡率。
我们回顾性分析了2011年至2023年期间在我科收治的所有962例PA的死亡率和生存时间：肢端肥大症（n = 306）、CD（n = 69）、大泌乳素瘤（n = 168）和MacroNFPA（n = 419）。
中位随访时间为10.2（5.2，15.2）年。以诊断时年龄为唯一显著预测因素，10年和20年后的总生存概率分别为90.9%和78.1%。整个队列中不同PA亚型的生存概率无显著差异。在诊断时年龄超过45岁的患者中，随访的前15年里四组之间的生存概率存在显著差异（p = 0.01）。在直接比较中，即使在调整年龄和性别后，CD的死亡风险仍显著高于肢端肥大症患者（HR 3.38 [CI 95% 1.07至10.60]）。
45岁后诊断为CD的患者在随访的前15年里生存概率显著低于其他PA亚型。调整年龄和性别后，所有其他PA亚型的生存概率相似。由于激素分泌性肿瘤医疗水平的进步，PA患者的死亡率可能越来越多地取决于肿瘤大小而非激素分泌过多。
