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Risk of recurrence in pituitary neuroendocrine tumors: a prospective study using a five-tiered classification.
J Clin Endocrinol Metab. 2017 Jun 23;:
Authors: Raverot G, Dantony E, Beauvy J, Vasiljevic A, Mikolasek S, Borson-Chazot F, Jouanneau E, Roy P, Trouillas J
Abstract
Background: Most pituitary neuroendocrine tumors (PitNET) show benign behavior, but a significant number are invasive, recur or resist to medical treatment. Based on a retrospective case-control study we recently proposed a classification of PitNETs of prognostic relevance. This prospective study aims to test the value of this classification in an independent patient cohort.
Methods: The cohort included patients of a single center operated upon a PitNET. Using a grading system based on invasion on MRI, immunocytochemical profile (ICC), Ki-67, mitotic index, and p53 positivity, tumors were classified. Progression-free survival of the graded tumors was calculated by the Kaplan-Meier method and compared using the Log-rank test. A multivariate analysis, using a Cox regression model, was also performed.
Results: 365 patients had grade 1a PitNETs (51.2%), followed by grade 2a (32.3%), 2b (8.8%) and 1b tumors (7.7%). Of 213 patients with a follow-up, 42% had recurrent (n=52) or progressive disease (n=37) at 3.5 years. Grade was a significant predictor of progression-free survival (p<0.001). Multivariate analysis indicated grade (p<0.001), age (p=0.035), and tumor type (p=0.028), as independent predictors of recurrence and/progression. This risk was 3.72-fold higher for a grade 2b tumor as compared to grade 1a tumor.
Conclusions: Our data suggest that classification of PitNETs into 5 grades is of prognostic value to predict post-operative tumor behavior and identifies patients who have a high risk of early recurrence or progression. It therefore will allow clinicians to adapt their therapeutic strategies and stratify patient in future clinical trials.
PMID: 28651368 [PubMed - as supplied by publisher]
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