背景:梭形细胞嗜酸细胞瘤(SCO)和颗粒细胞瘤(GCT)是罕见的原发性垂体肿瘤;这些病变的最佳治疗模式尚不清楚,大部分尚未探索。因此,利用国家登记册,我们分析了流行病学,管理模式,以及SCOs和GCTs的手术结果。
方法:国家癌症数据库(NCDB;2003-2017年)和监测,流行病学,和最终结果计划(SEER;2004-2018年)被查询为垂体SCOs或GCTs患者.发病率,手术切除的范围,亚完全切除病变的术后放疗使用率构成了主要结局.还通过事件发生时间Kaplan-Meier曲线分析了全因死亡率。
结果:SCO和GCT的年发病率分别为0.017和0.023/1,000,000。它们占NCDB登记的良性垂体瘤的0.1%。在研究期间,NCDB中共发现112,241例良性垂体肿瘤,其中SCOs83例(0.07%),GCTs59例(0.05%)。诊断时的中位年龄为55岁,44%是女性,出现时的中位最大肿瘤直径为2.1cm。54%的患者实现了总切除。10例患者(7%)进行了术后放疗。比较GCT和SCO患者,前者在诊断时更可能更年轻(48.0vs.分别为59.0;p<0.01)和女性(59%vs.34%,p=0.01)。GCT和SCO在诊断时的大小方面没有差异(中位最大直径:1.9cm与2.2cm,分别为;p=0.59)或总切除率(62%与49%,p=0.32)。在将SCO和GCT与垂体腺瘤进行年龄匹配后,性别,和肿瘤大小,前者不太可能接受总切除(53%vs.72%;p=0.03)。与垂体腺瘤患者相比,SCO和GCT患者的总生存期较短(p<0.01),30天死亡率较高(3.1%vs0.0%;p=0.013)。
结论:SCO和GCT是罕见的垂体瘤,他们的管理带来了特殊的挑战。总切除通常是不可能的,和辅助放疗可以在次全切除后使用。
BACKGROUND: Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and largely unexplored. Thus, using national registries, we analyze the epidemiology, management patterns, and surgical outcomes of SCOs and GCTs.
METHODS: The National Cancer Database (NCDB; years 2003-2017) and the Surveillance, Epidemiology, and End Results Program (SEER; years 2004-2018) were queried for patients with pituitary SCOs or GCTs. Incidence, extent of surgical resection, and rate of postoperative radiation use for subtotally resected lesions comprised the primary outcomes of interest. All-cause mortality was also analyzed via time-to-event Kaplan-Meier curves.
RESULTS: SCOs and GCTs have an annual incidence of 0.017 and 0.023 per 1,000,000, respectively. They comprise 0.1% of the benign pituitary tumors registered in NCDB. A total of 112,241 benign pituitary tumors were identified in NCDB during the study period, of which 83 (0.07%) were SCOs and 59 (0.05%) were GCTs. Median age at diagnosis was 55 years, 44% were females, and median maximal tumor diameter at presentation was 2.1 cm. Gross total resection was achieved in 54% patients. Ten patients (7%) had postoperative radiation. Comparing patients with GCTs versus SCOs, the former were more likely to be younger at diagnosis (48.0 vs. 59.0, respectively; p < 0.01) and female (59% vs. 34%, p = 0.01). GCTs and SCOs did not differ in terms of size at diagnoses (median maximal diameter: 1.9 cm vs. 2.2 cm, respectively; p = 0.59) or gross total resection rates (62% vs. 49%, p = 0.32). After matching SCOs and GCTs with pituitary adenomas on age, sex, and tumor size, the former were less likely to undergo gross total resection (53% vs. 72%; p = 0.03). Patients with SCOs and GCTs had a shorter overall survival when compared to patients with pituitary adenomas (p < 0.01) and a higher rate of thirty-day mortality (3.1% vs 0.0%; p = 0.013).
CONCLUSIONS: SCOs and GCTs are rare pituitary tumors, and their management entails particular challenges. Gross total resection is often not possible, and adjuvant radiation might be employed following subtotal resection.