Validation of a clinicopathological score for the prediction of post-surgical evolution of pituitary adenoma: retrospective analysis on 566 patients from a tertiary care centre

in European Journal of Endocrinology
Correspondence should be addressed to A Righi; Email: alberto.righi@ior.it
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Objective and design

A clinicopathological score has been proposed by Trouillas et al. to predict the evolution of pituitary adenomas. Aim of our study was to perform an independent external validation of this score and identify other potential predictor of post-surgical outcome.

Methods

The study sample included 566 patients with pituitary adenomas, specifically 253 FSH/LH-secreting, 147 GH-secreting, 85 PRL-secreting, 72 ACTH-secreting and 9 TSH-secreting tumours with at least 3-year post-surgical follow-up.

Results

In 437 cases, pituitary adenomas were non-invasive, with low (grade 1a: 378 cases) or high (grade 1b: 59 cases) proliferative activity. In 129 cases, tumours were invasive, with low (grade 2a: 87 cases) or high (grade 2b: 42 cases) proliferative activity. During the follow-up (mean: 5.8 years), 60 patients developed disease recurrence or progression, with a total of 130 patients with pituitary disease at last follow-up. Univariate analysis demonstrated a significantly higher risk of disease persistence and recurrence/progression in patients with PRL-, ACTH- and FSH/LH-secreting tumours as compared to those with somatotroph tumours, and in those with high proliferative activity (grade 1b and 2b) or >1 cm diameter. Multivariate analysis confirmed tumour type and grade to be independent predictors of disease-free-survival. Tumour invasion, Ki-67 and tumour type were the only independent prognostic factors of disease-free survival.

Conclusions

Our data confirmed the validity of Trouillas’ score, being tumour type and grade independent predictors of disease evolution. Therefore, we recommend to always consider both features, together with tumour histological subtype, in the clinical setting to early identify patients at higher risk of recurrence.

 

     European Society of Endocrinology

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References

  • 1

    OsamuraRYGrossmanAKorbonitsMKovacsKLopesMBSMatsunoATrouillasJ. Pituitary adenoma. In World Health Organization Classification of Tumours of Endocrine Organs4th ed. pp 1418. Eds LloydRVOsamuraRYKloppelG & RosaiJ. Lyon: IARC2017.

    • Search Google Scholar
    • Export Citation
  • 2

    RaverotGDantonyEBeauvyJVasiljevicAMikolasekSBorson-ChazotFJouanneauERoyPTrouillasJ. Risk of recurrence in pituitary neuroendocrine tumors: a prospective study using a five-tiered classification. Journal of Clinical Endocrinology and Metabolism 2017 102 33683374. (https://doi.org/10.1210/jc.2017-00773)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    AsaSLCasar-BorotaOChansonPDelgrangeEEarlsPEzzatSGrossmanAIkedaHInoshitaNKaravitakiN et al. From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): an International Pituitary Pathology Club proposal. Endocrine-Related Cancer 2017 24 C5C8. (https://doi.org/10.1530/ERC-17-0004)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    SaegerWLudeckeDKBuchfelderMFahlbuschRQuabbeHJPetersennS. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. European Journal of Endocrinology 2007 156 203216. (https://doi.org/10.1530/eje.1.02326)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    TrouillasJRoyPSturmNDantonyECortet-RudelliCViennetGBonnevilleJFAssakerRAugerCBrueT et al. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathologica 2013 126 123135. (https://doi.org/10.1007/s00401-013-1084-y)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    ChatzellisEAlexandrakiKIAndroulakisIIKaltsasG. Aggressive pituitary tumors. Neuroendocrinology 2015 101 87104. (https://doi.org/10.1159/000371806)

  • 7

    ScheithauerBWGaffeyTALloydRVSeboTJKovacsKTHorvathEYapicierOYoungWFJrMeyerFBKurokiT et al. Pathobiology of pituitary adenomas and carcinomas. Neurosurgery 2006 59 341353. (https://doi.org/10.1227/01.NEU.0000223437.51435.6E)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    LloydRVKovacsKYoungWFJr. Tumors of the pituitary. In World Health Organization Classification of Tumors: Pathology and Genetics: Tumors of Endocrine Organs3th ed. pp 1047. Eds DeLellisRALloydRVHeitzPU & EngC. Lyon: IARC2004.

    • Search Google Scholar
    • Export Citation
  • 9

    RighiAAgatiPSistoAFrankGFaustini-FustiniMAgatiRMazzatentaDFarnediAMenettiFMarucciG et al. A classification tree approach for pituitary adenomas. Human Pathology 2012 43 16271637. (https://doi.org/10.1016/j.humpath.2011.12.003)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    MarucciGFaustini-FustiniMRighiAPasquiniEFrankGAgatiRFoschiniMP. Thyrotropin-secreting pituitary tumours: significance of ‘atypical adenomas’ in a series of 10 patients and association with Hashimoto thyroiditis as a cause of delay in diagnosis. Journal of Clinical Pathology 2009 62 455459. (https://doi.org/10.1136/jcp.2008.061523)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    RighiAMorandiLLeonardiEFarnediAMarucciGSistoAFrankGFaustini-FustiniMZoliMMazzatentaD et al. Galectin-3 expression in pituitary adenomas as a marker of aggressive behavior. Human Pathology 2013 44 24002409. (https://doi.org/10.1016/j.humpath.2013.05.020)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    RighiAFaustini-FustiniMMorandiLMontiVAsioliSMazzatentaDBacciAFoschiniMP. The changing faces of corticotroph cell adenomas: the role of prohormone convertase 1/3. Endocrine 2017 56 286297. (https://doi.org/10.1007/s12020-016-1028-0)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    KnospESteinerEKitzKMatulaC. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993 33 610617.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    RaverotGVasiljevicAJouanneauETrouillasJ. A prognostic clinicopathologic classification of pituitary endocrine tumors. Endocrinology and Metabolism Clinics of North America 2015 44 1118. (https://doi.org/10.1016/j.ecl.2014.10.001)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    MiermeisterCPPetersennSBuchfelderMFahlbuschRLüdeckeDKHölskenABergmannMKnappeHUHansVHFlitschJ et al. Histological criteria for atypical pituitary adenomas – data from the German pituitary adenoma registry suggests modifications. Acta Neuropathologica Communications 2015 19 50. (https://doi.org/10.1186/s40478-015-0229-8)

    • Search Google Scholar
    • Export Citation
  • 16

    GejmanRSwearingenBHedley-WhyteET. Role of Ki-67 proliferation index and p53 expression in predicting progression of pituitary adenomas. Human Pathology 2008 39 758766. (https://doi.org/10.1016/j.humpath.2007.10.004)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    ChiloiroSBianchiADogliettoFde WaureCGiampietroAFuscoAIacovazzoDTartaglioneLDi NardoFSignorelliF et al. Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review. Pituitary 2014 17 267276. (https://doi.org/10.1007/s11102-013-0500-6)

    • Search Google Scholar
    • Export Citation
  • 18

    WierinckxAAugerCDevauchellePReynaudAChevallierPJanMPerrinGFevre-MontangeMReyCFigarella-BrangerD et al. A diagnostic marker set for invasion, proliferation, and aggressiveness of prolactin pituitary tumors. Endocrine-Related Cancer 2007 14 887900. (https://doi.org/10.1677/ERC-07-0062)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    NohTWJeongHJLeeMKKimTSKimSHLeeEJ. Predicting recurrence of nonfunctioning pituitary adenomas. Journal of Clinical Endocrinology and Metabolism 2009 94 44064413. (https://doi.org/10.1210/jc.2009-0471)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    ZadaGLinNLawsERJr. Patterns of extrasellar extension in growth hormone-secreting and nonfunctional pituitary macroadenomas. Neurosurgical Focus 2010 29 E4. (https://doi.org/10.3171/2010.7.FOCUS10155)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Del Basso De CaroMSolariDPagliucaFVillaAGuadagnoECavalloLMColaoAPettinatoGCappabiancaP. Atypical pituitary adenomas: clinical characteristics and role of ki-67 and p53 in prognostic and therapeutic evaluation. A series of 50 patients. Neurosurgical Review 2017 40 105114. (https://doi.org/10.1007/s10143-016-0740-9)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    LelotteJMourinAFomekongEMichotteARaftopoulosCMaiterD. Both invasiveness and proliferation criteria predict recurrence of non-functioning pituitary macroadenomas after surgery: a retrospective analysis of a monocentric cohort of 120 patients. European Journal of Endocrinology 2018 178 237246. (https://doi.org/10.1530/EJE-17-0965)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    MickoASWöhrerAWolfsbergerSKnospE. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. Journal of Neurosurgery 2015 122 803811. (https://doi.org/10.3171/2014.12.JNS141083)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    ZoliMMilaneseLBonfattiRSturialeCPasquiniEFrankGMazzatentaD. Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery. Journal of Neurosurgical Sciences 2016 60 485494.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    NagataYInoshitaNFukuharaNYamaguchi-OkadaMNishiokaHIwataTYoshimotoKYamadaS. Growth hormone-producing pituitary adenomas in childhood and young adulthood: clinical features and outcomes. Pituitary 2018 21 19. (https://doi.org/10.1007/s11102-017-0836-4)

    • Crossref
    • Search Google Scholar
    • Export Citation

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