背景:用于泌乳素瘤的内镜经蝶窦手术(ETSS)保留用于多巴胺激动剂(DA)抵抗,不容忍,或者中风.高缓解(总体67%,微泌乳素瘤高达90%),低复发率(5-20%)强调手术可能是一线治疗.
目的:报告泌乳素腺瘤队列中ETSS的结局。
方法:多中心回顾性队列研究137例泌乳素腺瘤患者(年龄38.2±13.7岁;61.3%为女性,中位随访时间28.0[15.0-55.5]个月)在2010-2019年间进行,并经组织病理学确认。
结果:术前催乳素水平中位数为166(98-837µg/L;男性996[159-2145µg/L]与雌性129[84-223µg/L],p<0.001)。56(40.9%)微泌乳素瘤,69(50.4%)大泌乳素瘤,包括7例(5.1%)巨大泌乳素瘤,而5例(3.6%)患者未检出腺瘤。男性有较大的肿瘤(大泌乳素瘤:38,71.7%)与31(36.9%),p<0.001;巨大泌乳素腺瘤:7(13.2%)与0(0.0%),(p<0.001)。15例(11.5%)泌乳素瘤分级为KNOSP-3,20例(15.3%)患者中KNOSP-4。主要适应症是DA不耐受(59,43.1%);男性14(26.4%)与女性45人(53.6%),p=0.006。长期缓解(即,无DA催乳素水平<1xULN)在87(63.5%)患者中实现,在预期的完全切除中更高(69/92[75.0%]),男性较低(25[47.2%]62名女性[73.8%],p=0.002)。短暂性DI(n=29,21.2%)是最常见的并发症。
结论:尽管大型泌乳素瘤和KNOSP3-4的比例很高,但总体长期缓解率为63.5%,微泌乳素瘤患者占83.3%。与女性相比,男性的缓解率较差。这些发现强调ETSS可能是治疗泌乳素瘤的安全有效的治疗方法。
Endoscopic transsphenoidal surgery (ETSS) for prolactinoma is reserved for dopamine agonist (DA) resistance, intolerance, or apoplexy. High remission (overall 67%, microprolactinoma up to 90%), low recurrence (5-20%) rates highlighted that surgery might be first-line treatment.
To report on outcomes of ETSS in a cohort of prolactinomas.
Multicenter retrospective cohort of 137 prolactinoma patients (age 38.2 ± 13.7 years; 61.3% female, median follow-up 28.0 [15.0-55.5] months) operated between 2010-2019 with histopathological confirmation.
Median preoperative prolactin levels were 166 (98-837 µg/L; males 996 [159-2145 µg/L] vs. females 129 [84-223 µg/L], p <0.001). 56 (40.9%) microprolactinomas, 69 (50.4%) macroprolactinomas, and 7 (5.1%) giant prolactinomas were included, whereas no adenoma was detected in 5 (3.6%) patients. Males had larger tumors (macroprolactinomas: 38, 71.7%) vs. 31 (36.9%), p <0.001; giant prolactinomas: 7 (13.2%) vs. 0 (0.0%), (p <0.001). Prolactinomas were graded as KNOSP-3 in 15 (11.5%), and KNOSP-4 in 20 (15.3%) patients. Primary indication was DA intolerance (59, 43.1%); males 14 (26.4%) vs. females 45 (53.6%), p = 0.006. Long-term remission (i.e., DA-free prolactin level <1xULN) was achieved in 87 (63.5%) patients, being higher in intended complete resection (69/92 [75.0%]), and lower in males (25 [47.2%] vs. 62 females [73.8%], p = 0.002). Transient DI (n = 29, 21.2%) was the most frequent complication.
Despite high proportions of macroprolactinoma and KNOSP 3-4, long-term remission rates were 63.5% overall, and 83.3% in microprolactinoma patients. Males had less favorable remission rate compared to females. These findings highlight that ETSS may be a safe and efficacious treatment to manage prolactinoma.