Predictors for Secondary Therapy After Surgical Resection of Non-Functioning Pituitary Adenomas

Summary

Context

Factors determining recurrence of non-functioning pituitary adenomas (NFAs) that require further therapy are unclear as are post-operative follow-up imaging guidelines

Objective

To identify predictors for secondary therapy after surgical resection of NFAs and use this knowledge to inform post-operative management

Design and Patients

A single-centre retrospective study of surgically resected NFAs in 108 patients followed for up to 15 years.

Measurements

Serial tumour images were analysed for size, location and growth rate (GR) and tissue analysed for hormone cell type and proliferation indices with secondary treatment as outcome measure.

Results

24 of 66 (36%) patients harboring a post-operative remnant required secondary treatment, all occurring within 10 years. No secondary treatment was required in any of 42 patients with complete tumour resection. Age, gender, remnant volume and tumour histology were not different between patients requiring and not requiring secondary therapy. Remnant GRs in those requiring secondary therapy was more than 10 fold higher (p<0.01). Tumours with a GR ≥80 mm³/year (Hazard Ratio HR: 8.1, Confidence Interval CI: 2.4 to 27.3, p<0.01) and those located in the suprasellar region (HR: 6.1, CI: 1.1 to 32, p=0.03) had a higher risk for secondary therapy. Tumour GR in the first 3 post-operative years correlated significantly (r² = 0.6, p<0.01) with GR during the period of follow up.

Conclusion

In surgically-resected NFAs further treatment is dependent on the presence of residual tumour, growth rate and location but not tumour histology. Post-operative growth rate of NFAs in the first 3 years of imaging can be used to tailor long-term follow-up to optimize use of health resources.

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