Chang Ting-Wei, Tseng Chun-Chia, Wang Yu-Chi, Huang Yin-Cheng, Hsu Peng-Wei, Chuang Chi-Cheng, Lee Cheng-Chi
Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 5, Fuxing St., Guishan Dist., 333423, Taoyuan, Taiwan.
School of Medicine, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, 300044, Hsinchu, Taiwan.
Discov Oncol. 2025 Aug 1;16(1):1453. doi: 10.1007/s12672-025-03313-5.
Growth hormone (GH)-secreting pituitary tumors cause serious systemic comorbidities, necessitating the achievement of gross total resection (GTR) and biochemical remission. This study aims to identify predictors of resection status and biochemical remission.
We retrospectively reviewed the records of 54 GH adenoma patients receiving endoscopic endonasal transsphenoidal approach (EETSA). Medical records and magnetic resonance imaging were reviewed for tumor size, volume, resection status, invasion status, and Knosp and Hardy-Wilson grades. We also classified invasion status into high- and low-grade groups. Biochemical remission was defined as an insulin-like growth factor 1 value within sex- and age-adjusted reference or a random GH level < 1.0 ng/mL.
The degrees of horizontal and vertical invasion based on preoperative Knosp and Hardy-Wilson grade were highly associated with intraoperative resection status (p = 0.0054, 0.0043 and 0.013 respectively). We also found more significant differences between resection status and higher-grade invasion (p = 0.0018, 0.006 and 0.0018, respectively). Hardy-Wilson grades and resection status were significantly associated with biochemical remission (p = 0.0484, 0.0252, and 0.0007, respectively). Although we observed no difference between outcomes with respect to micro- vs. macroadenoma, tumor size and volume were significantly associated with outcomes (p = 0.017, 0.0032, respectively). More significant differences were observed between biochemical remission and higher-grade Hardy-Wilson invasion grade (p = 0.0053 and 0.0075). Multivariate analysis showed that higher-grade Hardy-Wilson invasion correlated with resection status (p = 0.0481 and 0.0125); only resection status was associated with biochemical remission (p = 0.0101).
EETSA remains the best treatment option for GH adenomas. Biochemical remission was highly associated with invasion status and the possibility of achieving GTR. Aggressive resection for low-grade and pretreated high-grade tumors promises favorable outcomes.
分泌生长激素（GH）的垂体瘤会引发严重的全身合并症，因此需要实现肿瘤全切（GTR）并达到生化缓解。本研究旨在确定切除状态和生化缓解的预测因素。
我们回顾性分析了54例接受鼻内镜经蝶窦入路（EETSA）的GH腺瘤患者的记录。查阅病历和磁共振成像，以了解肿瘤大小、体积、切除状态、侵袭状态以及克诺斯普和哈迪-威尔逊分级。我们还将侵袭状态分为高级别和低级别组。生化缓解定义为胰岛素样生长因子1值在性别和年龄调整后的参考范围内，或随机GH水平<1.0 ng/mL。
基于术前克诺斯普和哈迪-威尔逊分级的水平和垂直侵袭程度与术中切除状态高度相关（分别为p = 0.0054、0.0043和0.013）。我们还发现切除状态与高级别侵袭之间的差异更为显著（分别为p = 0.0018、0.006和0.0018）。哈迪-威尔逊分级和切除状态与生化缓解显著相关（分别为p = 0.0484、0.0252和0.0007）。虽然我们观察到微腺瘤和大腺瘤的结果没有差异，但肿瘤大小和体积与结果显著相关（分别为p = 0.017、0.0032）。生化缓解与高级别哈迪-威尔逊侵袭分级之间的差异更为显著（p = 0.0053和0.0075）。多因素分析表明，高级别哈迪-威尔逊侵袭与切除状态相关（p = 0.0481和0.0125）；只有切除状态与生化缓解相关（p = 0.0101）。
EETSA仍然是GH腺瘤的最佳治疗选择。生化缓解与侵袭状态以及实现GTR的可能性高度相关。对低级别和预处理后的高级别肿瘤进行积极切除有望获得良好的结果。
