Abstract：
BACKGROUND: Silent corticotroph tumors (siACTH) represent a rare entity of pituitary tumors (PT), usually more aggressive than other PT. Few predictor factors of recurrence in the post-operative period have been proposed until now. This study aimed (1) to evaluate the clinical outcome of siACTH after surgery according to a five-tiered clinicopathological classification (2) to compare siACTH characteristics to ACTH-secreting macroadenomas (macroCD), and silent gonadotropinomas (siLH/FSH).
METHODS: Between 2008 and 2022, 29 siACTH out of 865 PT cases operated in one tertiary center were included. Clinical, paraclinical, histological, and surgical data were collected and compared to 25 macroCD and 143 siLH/FSH cases, respectively. The tumor grading was established according to both invasion (no = 1; yes = 2) and proliferation (no = a; yes = b). Progression-free survival was estimated using Kaplan-Meier method and log-rank test.
RESULTS: We identified 15 (51.7%) grade 1a, 11 (37.9%) grade 2a and 3 (10.3%) grade 2b siACTH with a trend for a 7-fold-time higher risk of progression/recurrence in grade 2b as compared to 1a (p = 0.06). The repartition of tumor grades was similar between the three subgroups, however a 5.7-fold-higher risk of progression was observed in grade 1a siACTH than in grade 1a siLH/FSH (p = 0.02). Compared to siLH/FSH, higher ACTH levels may help to preoperatively identify siACTH.
CONCLUSIONS: The five-tiered clinicopathological classification contribute to predict the risk of recurrence of operated siACTH tumors. Noteworthy, non-invasive and non-proliferative siACTH exhibit a less favorable outcomes than their siLH/FSH counterparts, which should prompt for a personalized follow up.
METHODS: Between 2008 and 2022, 29 siACTH out of 865 PT cases operated in one tertiary center were included. Clinical, paraclinical, histological, and surgical data were collected and compared to 25 macroCD and 143 siLH/FSH cases, respectively. The tumor grading was established according to both invasion (no = 1; yes = 2) and proliferation (no = a; yes = b). Progression-free survival was estimated using Kaplan-Meier method and log-rank test.
RESULTS: We identified 15 (51.7%) grade 1a, 11 (37.9%) grade 2a and 3 (10.3%) grade 2b siACTH with a trend for a 7-fold-time higher risk of progression/recurrence in grade 2b as compared to 1a (p = 0.06). The repartition of tumor grades was similar between the three subgroups, however a 5.7-fold-higher risk of progression was observed in grade 1a siACTH than in grade 1a siLH/FSH (p = 0.02). Compared to siLH/FSH, higher ACTH levels may help to preoperatively identify siACTH.
CONCLUSIONS: The five-tiered clinicopathological classification contribute to predict the risk of recurrence of operated siACTH tumors. Noteworthy, non-invasive and non-proliferative siACTH exhibit a less favorable outcomes than their siLH/FSH counterparts, which should prompt for a personalized follow up.
摘要：
背景：沉默的促肾上腺皮质激素肿瘤（siACTH）是垂体瘤（PT）的一种罕见实体，通常比其他PT更具侵略性。到目前为止，很少有人提出术后复发的预测因素。本研究旨在（1）根据五级临床病理分类评估siACTH术后的临床结局（2）比较siACTH与分泌ACTH的大腺瘤（macroCD）的特征，和无症状性腺促性腺激素瘤（siLH/FSH）。
方法：在2008年至2022年之间，在一个三级中心手术的865例PT病例中，有29例siACTH被纳入其中。临床,临床旁,组织学,收集手术数据，并与25例macroCD和143例siLH/FSH病例进行比较，分别。根据侵袭(否=1;是=2)和增殖(否=a;是=b)建立肿瘤分级。使用Kaplan-Meier方法和对数秩检验估计无进展生存期。
结果：我们确定了15（51.7%）1a级，11级（37.9%）2a级和3级（10.3%）2b级siACTH，与1a相比，2b级的进展/复发风险高7倍（p=0.06）。肿瘤等级的重新划分在三个亚组之间是相似的，然而,1a级siACTH的进展风险比1a级siLH/FSH高5.7倍(p=0.02).与siLH/FSH相比，更高的ACTH水平可能有助于术前识别siACTH。
结论：五级临床病理分类有助于预测手术siACTH肿瘤的复发风险。值得注意的是,非侵入性和非增殖性siACTH表现出不如其siLH/FSH对应物有利的结果，这应该会提示个性化的跟进。
方法：在2008年至2022年之间，在一个三级中心手术的865例PT病例中，有29例siACTH被纳入其中。临床,临床旁,组织学,收集手术数据，并与25例macroCD和143例siLH/FSH病例进行比较，分别。根据侵袭(否=1;是=2)和增殖(否=a;是=b)建立肿瘤分级。使用Kaplan-Meier方法和对数秩检验估计无进展生存期。
结果：我们确定了15（51.7%）1a级，11级（37.9%）2a级和3级（10.3%）2b级siACTH，与1a相比，2b级的进展/复发风险高7倍（p=0.06）。肿瘤等级的重新划分在三个亚组之间是相似的，然而,1a级siACTH的进展风险比1a级siLH/FSH高5.7倍(p=0.02).与siLH/FSH相比，更高的ACTH水平可能有助于术前识别siACTH。
结论：五级临床病理分类有助于预测手术siACTH肿瘤的复发风险。值得注意的是,非侵入性和非增殖性siACTH表现出不如其siLH/FSH对应物有利的结果，这应该会提示个性化的跟进。
