Andereggen Lukas, Christ Emanuel
Department of Neurosurgery, Kantonsspital Aarau, Aarau, 5001, Switzerland.
Facult of Medicine, University of Bern, Bern, Switzerland.
J Neurooncol. 2025 May;172(3):613-623. doi: 10.1007/s11060-025-04958-6. Epub 2025 Feb 4.
Opting for first-line surgery in carefully selected patients with microprolactinomas provides the advantage of avoiding long-term dopamine agonist (DA) medication and potential associated side effects. However, the lack of comprehensive long-term data poses a challenge in identifying those patients who would benefit the most from upfront surgery. To improve guidance in the selection process for microprolactinoma patients in clinical practice, we aimed to establish simple clinical and biochemical parameters predicting non-dependence on DAs.
Retrospective analysis of a prospectively maintained database, focusing on patients with microprolactinomas who underwent upfront surgery. We assessed clinical and biochemical risk factors for the patients' reliance on DAs at their latest follow-up using regression analysis. We next proceeded to conduct Receiver Operating Characteristic (ROC) analysis to determine the optimal threshold cutoff prolactin (PRL) level for practical application in clinical settings that best differentiates between surgical long-term remission status and long-term dependence on DAs.
A microadenoma was observed in 46 patients, of whom 12 (26%) exhibited long-term dependence on DAs at a median follow-up of 78 months. Baseline PRL values were significantly higher in patients with long-term DA dependence compared to those without (p = 0.05). High baseline PRL values (HR 23.9, 95% CI 1.0-593.7, p = 0.05), but not the presence of headache or male gender, were identified as independent predictors of long-term dependence on DAs. PRL thresholds for discriminating long-term DA dependence were estimated to be 290 µg/L (AUROC = 0.73, 95% CI 0.55-0.92, p = 0.03; sensitivity = 90%, specificity = 80%).
In patients with microprolactinomas, first-line surgery presents a favorable prospect for reducing reliance on DAs. However, for those with high PRL levels ≥ 290 µg/L at diagnosis, first-line surgery is not recommended, as the majority of them require adjuvant DA therapy in the long term.
对于精心挑选的微泌乳素瘤患者选择一线手术治疗，具有避免长期使用多巴胺激动剂（DA）药物及其潜在相关副作用的优势。然而，缺乏全面的长期数据给确定哪些患者能从早期手术中获益最大带来了挑战。为了在临床实践中改善微泌乳素瘤患者选择过程中的指导，我们旨在建立预测不依赖DA的简单临床和生化参数。
对一个前瞻性维护的数据库进行回顾性分析，重点关注接受早期手术的微泌乳素瘤患者。我们使用回归分析评估患者在最新随访时依赖DA的临床和生化风险因素。接下来，我们进行受试者操作特征（ROC）分析，以确定在临床环境中实际应用时区分手术长期缓解状态和长期依赖DA的最佳催乳素（PRL）水平阈值。
46例患者观察到微腺瘤，其中12例（26%）在中位随访78个月时表现出对DA的长期依赖。与无长期DA依赖的患者相比，长期DA依赖患者的基线PRL值显著更高（p = 0.05）。高基线PRL值（HR 23.9，95% CI 1.0 - 593.7，p = 0.05），而非头痛的存在或男性性别，被确定为长期依赖DA的独立预测因素。区分长期DA依赖的PRL阈值估计为290 μg/L（AUROC = 0.73，95% CI 0.55 - 0.92，p = 0.03；敏感性 = 90%，特异性 = 80%）。
对于微泌乳素瘤患者，一线手术在减少对DA的依赖方面前景良好。然而，对于诊断时PRL水平≥290 μg/L的患者，不建议进行一线手术，因为他们中的大多数长期需要辅助DA治疗。
