Long-Term Outcomes of Transsphenoidal Surgery for Management of Growth Hormone–Secreting Adenomas: Single-Center Results
Notice bibliographique
Résumé
Introduction: Transsphenoidal surgery is advocated as the first-line management of growth hormone (GH)-secreting adenomas. While disease control is defined by strict criteria for biochemical remission, the length of follow-up needed is not well defined in literature. In this report, the authors present their long-term remission rate and identify various predictive factors that might influence the clinical outcome. Materials and Methods: The authors conducted a single-institute retrospective analysis of all transsphenoidal procedures for GH-secreting adenomas from January 2000 to June 2016. The primary outcome was defined as biochemical remission according to the 2010 consensus criteria and measured at the 1-year mark postoperatively as well as on the last recorded follow-up appointment. Secondary variables included recurrence rate, patterns of clinical presentation, and outcome of adjuvant therapy including repeat surgery, and subgroup analysis for patients who have “biochemical or radiological discordance”— patients who achieved biochemical remission but with incongruent IGF1/GH or residual tumor on MRI. Recurrence-free survival analysis was conducted for patients who achieved remission at 1-year postop. Results: Eighty-one cases (45 females and 36 males) with confirmed acromegaly treated with transsphenoidal surgery were included (62 pure endoscopic cases and 19 microscopic endoscopic-assisted cases). Primary biochemical remission after surgery was achieved in 59 cases (73%) at 1-year mark postoperatively. However, only 41 patients (51%) remained in primary surgical remission (without any adjuvant treatment) at their last follow-up appointment indicating a recurrence rate of 31% (18/59 patients) over the duration of follow-up (average: 100 ± 61 months). Long-term remission rates for pure endoscopic and endoscopic-assisted cases appeared similar (48 vs. 52%, p = 0.6). Similarly, no significant difference in long-term remission was detected between primary surgery and repeat surgery (54 vs. 33%, p = 0.22). Long-term remission was significantly influenced by extent of surgical resection, cavernous sinus invasion (radiologically as well as surgically reported), preoperative IGF-1 levels, and early postoperative GH and IGF-1 levels (within 24–48 hours postoperative) as well as by the clinical grade with lower remission rates in patients with dysmorphic features and/or medical comorbidities (grades 2–3) compared with minimally symptomatic/silent cases (grade 1). Conclusion: Long-term surgical remission rate appears to be significantly less than “early” remission rates and is highly dependent on the extent of tumor resection. The authors advocate a long-term follow-up regimen and propose a clinical grading system that may aid in predicting long-term outcome in addition to the previously reported anatomical factors. The role of repeat surgery is highlighted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».