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Abstract：
OBJECTIVE: The aim of this study was to investigate the incidence and risk factors of new-onset hypopituitarism after gamma knife radiosurgery (GKRS) for pituitary adenomas in a single center.
METHODS: In this retrospective study, 241 pituitary adenoma patients who underwent GKRS from 1993 to 2016 were enrolled. These patients had complete endocrine, imaging, and clinical data before and after GKRS. The median follow-up time was 56.0 (range, 12.7-297.6) months.
RESULTS: Fifty patients (20.7%) developed new-onset hypopituitarism after GKRS, including hypogonadism (n = 22), hypothyroidism (n = 29), hypocortisolism (n = 20), and growth hormone deficiency (n = 4). The median time to new-onset hypopituitarism was 44.1 (range, 13.5-141.4) months. The rates of new-onset hypopituitarism were 7%, 16%, 20%, 39%, and 45% at 1, 3, 5, 10, and 15 years, respectively. For those patients treated with a single GKRS, sex (p = 0.012), suprasellar extension (p = 0.048), tumor volume (≥ 5 cm3) (p < 0.001), tumor progression (p = 0.001), pre-existing hypopituitarism (p = 0.011), and previous surgery (p = 0.009) were significantly associated with new-onset hypopituitarism in univariate analysis. In the multivariate analysis, tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism (hazard ratio [HR] = 3.401, 95% confidence interval [CI] = 1.708-6.773, p < 0.001 and HR = 3.594, 95% CI = 1.032-12.516, p = 0.045, respectively). For patients who received 2 or more times GKRS, no risk factors associated with new-onset hypopituitarism were found.
CONCLUSIONS: New-onset hypopituitarism was not uncommon after GKRS for pituitary adenomas. In this study, large tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism after a single GKRS.
METHODS: In this retrospective study, 241 pituitary adenoma patients who underwent GKRS from 1993 to 2016 were enrolled. These patients had complete endocrine, imaging, and clinical data before and after GKRS. The median follow-up time was 56.0 (range, 12.7-297.6) months.
RESULTS: Fifty patients (20.7%) developed new-onset hypopituitarism after GKRS, including hypogonadism (n = 22), hypothyroidism (n = 29), hypocortisolism (n = 20), and growth hormone deficiency (n = 4). The median time to new-onset hypopituitarism was 44.1 (range, 13.5-141.4) months. The rates of new-onset hypopituitarism were 7%, 16%, 20%, 39%, and 45% at 1, 3, 5, 10, and 15 years, respectively. For those patients treated with a single GKRS, sex (p = 0.012), suprasellar extension (p = 0.048), tumor volume (≥ 5 cm3) (p < 0.001), tumor progression (p = 0.001), pre-existing hypopituitarism (p = 0.011), and previous surgery (p = 0.009) were significantly associated with new-onset hypopituitarism in univariate analysis. In the multivariate analysis, tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism (hazard ratio [HR] = 3.401, 95% confidence interval [CI] = 1.708-6.773, p < 0.001 and HR = 3.594, 95% CI = 1.032-12.516, p = 0.045, respectively). For patients who received 2 or more times GKRS, no risk factors associated with new-onset hypopituitarism were found.
CONCLUSIONS: New-onset hypopituitarism was not uncommon after GKRS for pituitary adenomas. In this study, large tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism after a single GKRS.
摘要：
目的：本研究的目的是调查单中心垂体腺瘤伽玛刀放射外科（GKRS）术后新发垂体功能减退的发生率和危险因素。
方法：在这项回顾性研究中，纳入了从1993年至2016年接受GKRS的241例垂体腺瘤患者。这些病人有完全的内分泌，成像,GKRS前后的临床资料。中位随访时间为56.0（范围，12.7-297.6）个月。
结果：50例患者（20.7%）在GKRS后出现新发垂体功能减退，包括性腺功能减退（n=22），甲状腺功能减退（n=29），皮质醇减少症（n=20），生长激素缺乏（n=4）。新发垂体功能减退的中位时间为44.1（范围，13.5-141.4）个月。新发垂体功能减退症的发生率为7%，16%,20%,39%,在1、3、5、10和15年时为45%，分别。对于那些接受单一GKRS治疗的患者，性别（p=0.012），鞍上延伸（p=0.048），肿瘤体积（≥5cm3）（p<0.001），肿瘤进展（p=0.001），预先存在的垂体功能减退（p=0.011），在单因素分析中,既往手术(p=0.009)与新发垂体功能减退显著相关.在多变量分析中，肿瘤体积(≥5cm3)和肿瘤进展与新发垂体功能减退症相关(风险比[HR]=3.401,95%置信区间[CI]=1.708~6.773,p<0.001,HR=3.594,95%CI=1.032~12.516,p=0.045).对于接受2次或更多次GKRS的患者，未发现与新发垂体功能减退症相关的危险因素.
结论：垂体腺瘤GKRS治疗后，新发垂体功能减退并不少见。在这项研究中,大肿瘤体积(≥5cm3)和肿瘤进展与单次GKRS后新发垂体功能减退症相关.
方法：在这项回顾性研究中，纳入了从1993年至2016年接受GKRS的241例垂体腺瘤患者。这些病人有完全的内分泌，成像,GKRS前后的临床资料。中位随访时间为56.0（范围，12.7-297.6）个月。
结果：50例患者（20.7%）在GKRS后出现新发垂体功能减退，包括性腺功能减退（n=22），甲状腺功能减退（n=29），皮质醇减少症（n=20），生长激素缺乏（n=4）。新发垂体功能减退的中位时间为44.1（范围，13.5-141.4）个月。新发垂体功能减退症的发生率为7%，16%,20%,39%,在1、3、5、10和15年时为45%，分别。对于那些接受单一GKRS治疗的患者，性别（p=0.012），鞍上延伸（p=0.048），肿瘤体积（≥5cm3）（p<0.001），肿瘤进展（p=0.001），预先存在的垂体功能减退（p=0.011），在单因素分析中,既往手术(p=0.009)与新发垂体功能减退显著相关.在多变量分析中，肿瘤体积(≥5cm3)和肿瘤进展与新发垂体功能减退症相关(风险比[HR]=3.401,95%置信区间[CI]=1.708~6.773,p<0.001,HR=3.594,95%CI=1.032~12.516,p=0.045).对于接受2次或更多次GKRS的患者，未发现与新发垂体功能减退症相关的危险因素.
结论：垂体腺瘤GKRS治疗后，新发垂体功能减退并不少见。在这项研究中,大肿瘤体积(≥5cm3)和肿瘤进展与单次GKRS后新发垂体功能减退症相关.
