Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients
Personalized postoperative management of patients with pituitary adenomas requires an early risk stratification system.
We reviewed 501 cases operated between 10/27/2011 and 5/5/2016 by a single neurosurgeon. We determined biochemical remission and tumor resection at 3 months, and biochemical recurrence, tumor recurrence, radiation and reoperation during follow-up. We considered age, gender, tumor diameter, cavernous sinus invasion (CSI) by MRI, diagnostic category (clinical, biochemical and immunohistochemical), and proliferation markers in a Cox proportional hazards model. We built predictive models with the significant parameters and used Kaplan–Meier survival curves for time-dependent analyses.
The 501 cases comprised 141 functional and 360 nonfunctional adenomas. Tumor diameter, CSI, and ki-67 index predicted long-term events. Model 1 (CSI, diameter ≥ 2.9 cm and ki-67 > 3%) identified 18 (3.6%) adenomas and predicted persistent hypersecretory syndrome and residual tumor with 98.7% specificity (OR 8.6; CI 3.0–24.7). Model 2 (ki-67 > 3% and CSI) identified 48 (9.6%) adenomas and had 93.1% specificity (OR 3.3; CI 1.8–6.0). Model 3 (ki-67 > 3%, mitoses and p53, former “atypical” adenoma) identified 26 (5.2%) adenomas and had 96.0% specificity (OR 2.3; CI 1.0–5.0). Model 1 best predicted the long-term event-free survival and was strengthened when Knosp 3–4 CSI grades were used. Model 2 better identified the smaller adenomas at risk. Among the WHO 2017 special PA subtypes, patients with silent corticotroph adenoma had a lower event-free survival than ACTH-negative nonfunctional adenomas.
Use of CSI, ki-67 and tumor diameter in prediction models facilitates tailored surveillance and management of patients with pituitary adenomas.
KeywordsPituitary adenoma Cavernous sinus invasion Ki-67 Diameter Atypical adenoma Aggressive adenoma
Cavernous sinus invasion
Positive predictive value
Negative predictive value
Silent ACTH-positive adenoma
Emilee Wehunt, research coordinator responsible for regulatory aspects pertaining to this study.
Compliance with ethical standards
Conflict of interest
The authors have nothing to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of Emory’s institutional and/or national research committee.
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