Costachescu Mihai, Sima Oana-Claudia, Stanciu Mihaela, Valea Ana, Carsote Mara, Nistor Claudiu, Ciobica Mihai-Lucian
Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania.
PhD Doctoral School of "Carol Davila" University of Medicine and Pharmacy, 010825 Bucharest, Romania.
Cancers (Basel). 2024 Oct 14;16(20):3477. doi: 10.3390/cancers16203477.
Non-functioning (NF) accidentally detected PitNETs (PIs) are common findings of CT/MRI scans currently. Data concerning their behavior vary, and some PIs will potentially experience a size change over time that might become clinically relevant.
We aimed to evaluate CT-related PIs diameters following 3 aspects: a cross-sectional analysis based on the age' groups at first PI diagnosis and on the gender distribution and a longitudinal analysis in PIs with <0.5 cm versus ≥0.5 cm as the largest diameter at baseline.
A retrospective, real-life, multi-centric study in adults with NF micro-PIs was performed.
208 subjects (92.79% females) were included (average age 43.18 ± 12.58 y). The mean largest diameter (between transversal and longitudinal diameters) was 0.55 ± 0.16cm, and 44.71% of the PIs were located on the right part of the pituitary gland. The patients were divided into 10 age-groups (21 to 70 y), and no difference was observed between the mean largest diameters of these groups ( = 0.693). Females and males had a similar age at PIs diagnosis ( = 0.353), transverse diameter ( = 0.910), longitudinal diameter ( = 0.229), and PI location ( = 0.368). Serial CT scans (2 to 4 per patient) included a median (Q1-Q3) of 20 (12-36) months for the second CT scan, 58 (36-84) for the third CT scan, 78 (53-118) for the fourth CT scan, and a total follow-up between baseline and last CT scan of 40 (13-72) months. The initial largest diameter correlated with the diameter change between the baseline and the last CT (r = -0.575, = 0.000). The largest PI diameter was similar between each serial CT scan ( = 0.840). According to the cut-off value of 0.5 cm diameter (for initial largest tumor diameter), group A (N = 78, 37.50%, <0.5 cm) and group B (N = 130, 62. 50%; ≥0.5 cm) had similar age at baseline (43.83 ± 12.72 versus 42.79 ± 12.54 y, = 0.565) and PIs locations (right, left, median). The largest PI diameter remained smaller in group A versus B amid the second CT scan ( = 0.000) and the last CT scan ( = 0.009). The largest diameter change from the first to the last CT scan showed an increase in group A (median of +0.10 cm, = 0.000) and a decrease in group B (median of -0.01 cm, = 0.002); this diameter change was different in group A versus B ( = 0.000). The cumulative probability of tumor-growth-free survival showed different survival functions (log rank = 0.000): group A exhibited a more gradual decrease versus B; at 60 months, the cumulative probability was 0.32 ± 0.08 for group A versus 0.75 ± 0.07 for B. During follow-up, all PIs remained NF, and no hypopituitarism was noted (as limits, we mention that dynamic hypopituitarism testing was selectively performed).
NF micro-PIs in adults showed a similar age and sex distribution. During follow-up, PIs with a largest diameter < 0.5 cm increased after a median of 40 months but remained <1 cm, while in PIs with ≥0.5 cm, the largest diameter decreased. This highlights a lower predictability in tumor behavior than expected, particularly in larger micro-PIs that, overall, remained without relevant clinical implications after surveillance.
无功能（NF）意外发现的垂体神经内分泌肿瘤（PitNETs，PIs）是目前CT/MRI扫描的常见结果。关于其行为的数据各不相同，一些PIs可能会随着时间推移出现大小变化，这可能具有临床相关性。
我们旨在从三个方面评估与CT相关的PIs直径：基于首次PI诊断时的年龄组和性别分布的横断面分析，以及以基线时最大直径<0.5 cm与≥0.5 cm的PIs进行纵向分析。
对患有NF微PIs的成年人进行了一项回顾性、真实世界、多中心研究。
纳入208名受试者（92.79%为女性）（平均年龄43.18±12.58岁）。平均最大直径（横径与纵径之间）为0.55±0.16cm，44.71%的PIs位于垂体右侧。患者分为10个年龄组（21至70岁），这些组的平均最大直径之间未观察到差异（P = 0.693）。女性和男性在PI诊断时年龄相似（P = 0.353），横径（P = 0.910）、纵径（P = 0.229）以及PI位置（P = 0.368）也相似。系列CT扫描（每位患者2至4次）中，第二次CT扫描的时间中位数（四分位数间距）为20（12 - 36）个月，第三次为58（36 - 84）个月，第四次为78（53 - 118）个月，基线至最后一次CT扫描的总随访时间为40（13 - 72）个月。初始最大直径与基线和最后一次CT之间的直径变化相关（r = -0.575，P = 0.000）。每次系列CT扫描之间的最大PI直径相似（P = 0.840）。根据直径0.5 cm的截断值（用于初始最大肿瘤直径），A组（N = 78，37.50%，<0.5 cm）和B组（N = 130，62.50%；≥0.5 cm）在基线时年龄相似（43.83±12.72岁对42.79±12.54岁，P = 0.565）且PI位置（右侧、左侧、中间）相似。在第二次CT扫描（P = 0.000）和最后一次CT扫描（P = 0.009）时，A组的最大PI直径仍小于B组。从第一次到最后一次CT扫描的最大直径变化显示A组增加（中位数为+0.10 cm，P = 0.000），B组减少（中位数为 -0.01 cm，P = 0.002）；A组与B组的这种直径变化不同（P = 0.000）。无肿瘤生长生存的累积概率显示出不同的生存函数（对数秩检验P = 0.000）：A组与B组相比下降更为缓慢；在60个月时，A组的累积概率为0.32±0.08，B组为0.75±0.07。随访期间，所有PIs仍为NF，未观察到垂体功能减退（作为限制条件，我们提到选择性地进行了动态垂体功能减退测试）。
成人NF微PIs显示出相似的年龄和性别分布。随访期间，最大直径<0.5 cm的PIs在中位40个月后增大但仍<1 cm，而最大直径≥0.5 cm的PIs中，最大直径减小。这突出表明肿瘤行为的可预测性低于预期，特别是在较大的微PIs中，总体而言，监测后仍无相关临床意义。
