PDF(Sci-hub)
Abstract：
BACKGROUND: This study aimed to investigate preoperative somatostatin analogs (SSAs) treatment on the surgical outcome in patients with acromegaly.
METHODS: An analysis of 358 patients with acromegaly was conducted. The preoperative medical therapy group (81 patients) received SSA treatment for at least 3 months prior to surgery, while the primary surgery group (277 patients) underwent transsphenoidal surgery directly. Follow-up duration was ≥3 months. Tumor invasion was evaluated by magnetic resonance imaging (MRI) and classified according to the Knosp grading system.
RESULTS: Most patients were diagnosed with macroadenoma. Among all patients (Knosp grades 0-4), preoperative SSA therapy did not significantly improve the curative effect of surgery, according to the levels of growth hormone (GH) and/or insulin-like growth factor 1 (IGF-1) markers. In patients with macroadenoma (Knosp grades 1-3), the remission rates were significantly higher in the SSA group compared to the surgery group when considering GH (56.4% vs. 37.3%, P = 0.048) and IGF-1 (43.2% vs. 17.6%, P = 0.004). In the preoperative medical therapy group, long-term use of SSAs (>6 months) led to higher remission rates (GH, 72.2% vs. 51.0%; and IGF-1, 61.1% vs. 29.8%; P = 0.12 and 0.02, respectively].
CONCLUSIONS: The long-term preoperative SSAs treatment may improve the surgical curative rate in acromegalic patients with invasive macroadenomas (Knosp grades 1-3).
METHODS: An analysis of 358 patients with acromegaly was conducted. The preoperative medical therapy group (81 patients) received SSA treatment for at least 3 months prior to surgery, while the primary surgery group (277 patients) underwent transsphenoidal surgery directly. Follow-up duration was ≥3 months. Tumor invasion was evaluated by magnetic resonance imaging (MRI) and classified according to the Knosp grading system.
RESULTS: Most patients were diagnosed with macroadenoma. Among all patients (Knosp grades 0-4), preoperative SSA therapy did not significantly improve the curative effect of surgery, according to the levels of growth hormone (GH) and/or insulin-like growth factor 1 (IGF-1) markers. In patients with macroadenoma (Knosp grades 1-3), the remission rates were significantly higher in the SSA group compared to the surgery group when considering GH (56.4% vs. 37.3%, P = 0.048) and IGF-1 (43.2% vs. 17.6%, P = 0.004). In the preoperative medical therapy group, long-term use of SSAs (>6 months) led to higher remission rates (GH, 72.2% vs. 51.0%; and IGF-1, 61.1% vs. 29.8%; P = 0.12 and 0.02, respectively].
CONCLUSIONS: The long-term preoperative SSAs treatment may improve the surgical curative rate in acromegalic patients with invasive macroadenomas (Knosp grades 1-3).
摘要：
背景：本研究旨在探讨术前生长抑素类似物（SSAs）治疗对肢端肥大症患者手术效果的影响。
方法：对358例肢端肥大症患者进行分析。术前药物治疗组（81例）在手术前接受SSA治疗至少3个月，而主要手术组（277例）直接进行经蝶入路手术。随访时间≥3个月。通过磁共振成像（MRI）评估肿瘤侵袭，并根据Knosp分级系统进行分类。
结果：大多数患者被诊断为大腺瘤。在所有患者中（Knosp等级0-4），术前SSA治疗未显著提高手术疗效,根据生长激素（GH）和/或胰岛素样生长因子1（IGF-1）标记的水平。大腺瘤患者（Knosp1-3级），考虑GH时，SSA组的缓解率明显高于手术组(56.4%vs.37.3%,P=0.048）和IGF-1（43.2%vs.17.6%,P=0.004)。在术前药物治疗组中，长期使用SSA(>6个月)导致更高的缓解率(GH，72.2%vs.51.0%；IGF-1，61.1%vs.29.8%；P分别=0.12和0.02]。
结论：术前长期SSA治疗可提高肢端肥大症伴侵袭性巨腺瘤(Knosp1-3级)患者的手术治愈率。
方法：对358例肢端肥大症患者进行分析。术前药物治疗组（81例）在手术前接受SSA治疗至少3个月，而主要手术组（277例）直接进行经蝶入路手术。随访时间≥3个月。通过磁共振成像（MRI）评估肿瘤侵袭，并根据Knosp分级系统进行分类。
结果：大多数患者被诊断为大腺瘤。在所有患者中（Knosp等级0-4），术前SSA治疗未显著提高手术疗效,根据生长激素（GH）和/或胰岛素样生长因子1（IGF-1）标记的水平。大腺瘤患者（Knosp1-3级），考虑GH时，SSA组的缓解率明显高于手术组(56.4%vs.37.3%,P=0.048）和IGF-1（43.2%vs.17.6%,P=0.004)。在术前药物治疗组中，长期使用SSA(>6个月)导致更高的缓解率(GH，72.2%vs.51.0%；IGF-1，61.1%vs.29.8%；P分别=0.12和0.02]。
结论：术前长期SSA治疗可提高肢端肥大症伴侵袭性巨腺瘤(Knosp1-3级)患者的手术治愈率。
