目的:多巴胺激动剂(DA)是泌乳素瘤的一线治疗。然而,一些患者对DA没有反应,被认为是耐药.在这项研究中,我们回顾性分析DA耐药的泌乳素腺瘤患者经蝶窦手术(TSS)后的结局.
方法:本研究回顾性纳入了94例接受TSS治疗的DA耐药泌乳素腺瘤患者。术后早期缓解率,催乳素(PRL)水平,并对复发率进行分析。
结果:在94名耐DA患者中,47(50%)在手术后1周实现早期缓解,包括41.18%的大泌乳素瘤患者和73.08%的微泌乳素瘤患者。术后第一天PRL水平显著低于术前PRL水平(p<0.001)。大泌乳素瘤和微泌乳素瘤的总切除率为,分别,75和96.15%。高泌乳素血症和肿瘤复发,分别,在31.91和19.15%的患者中发现,随访时间为39.53±2.172个月(范围3-86)。在浸润性泌乳素瘤(p=0.021)或术前PRL水平≥200ng/ml(p=0.029)的患者中,高泌乳素血症的复发率更高。单因素logistic回归显示肿瘤最大直径较大(p=0.045),侵袭性泌乳素瘤(p=0.002),术后早期缓解(p=0.004)是肿瘤复发的重要预测因素。然而,使用多元逐步逻辑回归,只有侵袭性和术后早期缓解仍然显着。
结论:肿瘤侵袭性和术前PRL水平是TSS术后高泌乳素血症复发的重要预测因素。对于肿瘤复发,侵袭性和术后早期缓解是独立预测因素。
OBJECTIVE: Dopamine agonists (DA) comprise first-line treatment for
prolactinomas. However, some patients show no response to DA and are considered resistant. In this
study, we retrospectively analyzed the outcomes of DA-resistant prolactinoma patients after transsphenoidal surgery (TSS).
METHODS: A total of 94 consecutive patients with DA-resistant
prolactinomas who underwent TSS were retrospectively enrolled in the present
study. Early postoperative remission rate, prolactin (PRL) levels, and recurrence rate were analyzed.
RESULTS: Of 94 DA-resistant patients, 47 (50%) achieved early remission 1 week post-surgery, including 41.18% of macroprolactinoma patients and 73.08% of microprolactinoma patients. PRL levels on the first postoperative day were significantly lower than preoperative PRL levels (p < 0.001). Total resection rate in macro- and microprolactinomas were, respectively, 75 and 96.15%. A recurrence of hyperprolactinemia and tumor was, respectively, found in 31.91 and 19.15% of patients with a follow-up of 39.53 ± 2.172 months (range 3-86). A higher hyperprolactinemia recurrence was observed in patients with invasive
prolactinomas (p = 0.021) or preoperative PRL levels ≥ 200 ng/ml (p = 0.029). Univariate logistic regression indicated that larger maximum tumor diameter (p = 0.045), invasive prolactinomas (p = 0.002), and absence of early postoperative remission (p = 0.004) were significant predictors of tumor recurrence. However, using multivariate stepwise logistic regression, only invasiveness and early postoperative remission remained significant.
CONCLUSIONS: Tumor invasiveness and preoperative PRL levels were significant predictors of hyperprolactinemia recurrence after TSS. For tumor recurrence, invasiveness and early postoperative remission were independent predictors.