Osorio Robert C, Kabir Aymen, Haddad Alexander F, Badani Aarav, Khela Harmon, Saha Atul, Juncker Ryan, Peeran Zain, Theodosopoulos Philip, Kunwar Sandeep, Gurrola Jose, El-Sayed Ivan H, Blevins Lewis, Aghi Manish K
Departments of1Neurological Surgery and.
2Otolaryngology Head and Neck Surgery, University of California, San Francisco, California.
J Neurosurg. 2024 Nov 15;142(3):756-765. doi: 10.3171/2024.7.JNS24373. Print 2025 Mar 1.
There is persistent debate in the literature surrounding the true predictors of biochemical remission after resection of somatotroph adenoma. A multimodal analysis of a large number of patients is needed to better understand which patients may be at higher or lower risk for remission failure after surgery.
A retrospective review was performed on patients undergoing somatotroph adenoma resection. Biochemical remission was defined as age- and sex-adjusted normalization of serum insulin growth factor-1 (IGF-1) levels at least 6 months after surgery. Patient case characteristics and clinicopathologic variables were tested for statistical associations with remission and were included in a random forest machine learning model to assess for their importance in determining remission status. Preoperative variables found to be significant remission predictors on statistical testing and important in the random forest model were subsequently assessed via receiver operating characteristic (ROC) analysis to determine numeric thresholds that optimally predicted preoperative likelihood of remission success or failure.
Eighty patients were identified with somatotroph adenoma who underwent transsphenoidal resection, with 60 patients (75%) achieving biochemical remission. Statistical testing found that patients with failed remission were more likely to have larger tumors (1.9 vs 1.6 cm by the largest axis, p = 0.014; and 3.61 vs 2.66 cm3 by 3D volume, p = 0.013) that invaded the cavernous sinus more frequently (70% vs 22% of patients, p < 0.001) and have higher preoperative IGF-1 level (860 vs 660 ng/ml, p = 0.044). An optimized random forest machine learning model with 10,000 iterations found that tumor size, preoperative growth hormone and IGF-1 levels, and cavernous sinus invasion were important preoperative predictors of remission status. ROC analysis revealed that 96% of patients with preoperative 3D tumor volume less than 1.51 cm3 (area under the curve [AUC] 0.691, p = 0.003) and 100% with nonadjusted preoperative IGF-1 level less than 718.5 ng/ml (AUC 0.736, p = 0.002) achieved remission.
Important preoperative predictors of postoperative remission for somatotroph adenoma resection include serum IGF-1 level, cavernous sinus invasion, and tumor size. Ninety-five percent of patients who achieved postoperative remission had preoperative 3D tumor volume less than 1.51 cm3.
围绕生长激素腺瘤切除术后生化缓解的真正预测因素，文献中一直存在争议。需要对大量患者进行多模式分析，以更好地了解哪些患者术后缓解失败的风险可能更高或更低。
对接受生长激素腺瘤切除术的患者进行回顾性研究。生化缓解定义为术后至少6个月血清胰岛素样生长因子-1（IGF-1）水平经年龄和性别校正后恢复正常。对患者的病例特征和临床病理变量进行统计分析，以确定其与缓解的相关性，并纳入随机森林机器学习模型，以评估它们在确定缓解状态中的重要性。对在统计检验中发现是显著缓解预测因素且在随机森林模型中很重要的术前变量，随后通过受试者操作特征（ROC）分析进行评估，以确定最佳预测缓解成功或失败术前可能性的数值阈值。
确定80例接受经蝶窦切除术的生长激素腺瘤患者，其中60例（75%）实现生化缓解。统计分析发现，缓解失败的患者更有可能有更大的肿瘤（最大径1.9 vs 1.6 cm，p = 0.014；三维体积3.61 vs 2.66 cm3，p = 0.013），更频繁侵犯海绵窦（70% vs 22%的患者，p < 0.001），且术前IGF-1水平更高（860 vs 660 ng/ml，p = 0.044）。一个经过10000次迭代优化的随机森林机器学习模型发现，肿瘤大小、术前生长激素和IGF-1水平以及海绵窦侵犯是缓解状态的重要术前预测因素。ROC分析显示，术前三维肿瘤体积小于1.51 cm3的患者中96%实现缓解（曲线下面积[AUC] 0.691，p = 0.003），术前未校正的IGF-1水平小于718.5 ng/ml的患者中100%实现缓解（AUC 0.736，p = 0.002）。
生长激素腺瘤切除术后缓解的重要术前预测因素包括血清IGF-1水平、海绵窦侵犯和肿瘤大小。术后实现缓解的患者中95%术前三维肿瘤体积小于1.51 cm3。
