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Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients

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Abstract

Background

Personalized postoperative management of patients with pituitary adenomas requires an early risk stratification system.

Methods

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.

Results

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.

Conclusion

Use of CSI, ki-67 and tumor diameter in prediction models facilitates tailored surveillance and management of patients with pituitary adenomas.

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Abbreviations

CSI:

Cavernous sinus invasion

PPV:

Positive predictive value

NPV:

Negative predictive value

SD:

Standard deviation

CD:

Cushing’s disease

ACM:

Acromegaly

NFA:

Non-functional adenoma

SCA:

Silent ACTH-positive adenoma

ACTH:

Adrenocorticotropic hormone

PA:

Pituitary adenomas

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Acknowledgements

Emilee Wehunt, research coordinator responsible for regulatory aspects pertaining to this study.

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Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    A. L. Pappy II & C. Bicknese

  2. Emory Rollins School of Public Health, Atlanta, GA, USA

    A. Savinkina

  3. Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA

    S. Neill

  4. Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA

    N. M. Oyesiku & A. G. Ioachimescu

  5. Department of Neurosurgery, Emory University School of Medicine, 1365 B Clifton Rd NE, Atlanta, GA, USA

    N. M. Oyesiku & A. G. Ioachimescu

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  1. A. L. Pappy II
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  2. A. Savinkina
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  3. C. Bicknese
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Correspondence to A. G. Ioachimescu.

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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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Pappy, A.L., Savinkina, A., Bicknese, C. et al. Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients. Pituitary 22, 520–531 (2019). https://doi.org/10.1007/s11102-019-00982-8

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