Endoscopic Endonasal Surgery for Prolactinomas: Prognostic Factors for Disease Control and Management of Persistent Disease
Notice bibliographique
Résumé
Objective: Prolactinomas are the most common type of functioning pituitary neoplasms. The endoscopic endonasal approach (EEA) is currently the state-of-the-art for the surgical treatment of pituitary tumors. However, only a limited number of studies have focused on the results of EEA for the treatment of prolactinomas. To assess the effectiveness of EEA for prolactinoma surgery, analyze surgical indications, identify factors related with disease remission, and present our approach for management of persistent disease. Methods: This retrospective study included 47 prolactinomas operated via EEA in two high-volume academic pituitary centers over 10 years, with a mean follow-up of 59.9 months. The primary endpoints were “early disease remission” (defined as normoprolactinemia within the first three postoperative months without dopamine agonist (DA) treatment) and “last follow-up remission” (defined as normoprolactinemia at last follow-up, irrespective of DA treatment). Patients’ biochemical, clinical, radiological, and treatment parameters were investigated. Results: Resistance and intolerance to DA were indications for surgery in 76.7%. Overall, early disease remission was achieved in 51.1%; while for microprolactinomas and microprolactinomas enclosed by the pituitary in 80% and 100%, respectively. Early disease remission was correlated with female gender ( p = 0.03), lower preoperative PRL levels ( p = 0.014), microadenoma ( p = 0.001), lack of radiological hemorrhage ( p = 0.001), absence of cavernous sinus (CS) invasion ( p < 0.001), and extent of resection (EOR; p <0.001). Biochemical recurrence was recorded in 8.3%. Persistent disease was reported in 48.9% of patients, with 47% of them achieving remission at last follow-up with DA therapy alone. In cases where hyperprolactinemia was severe or the patient remained symptomatic after the pharmacological maneuvers ( n = 6), repeat EEA and/or radiotherapy were utilized, with 66.7% of cases achieving remission. Last follow-up remission was achieved in 74.8% of patients overall, with symptomatic improvement in nearly 95.8%. Factors predicting last follow-up remission were no previous operation ( p = 0.001), absence of CS invasion ( p = 0.01), and EOR ( p < 0.001). Conclusion: EEA is an effective treatment option and could represent a viable alternative for selected cases, such as centrally located microprolactinomas. Surgery alone is unlikely to achieve disease remission in almost half of the cases. However, its application as part of a multidisciplinary approach may lead to long-term disease control in three quarters of patients with significant symptomatic improvement in an even greater proportion. Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».