背景:催乳素瘤是最常见的垂体腺瘤,目前的治疗方案包括多巴胺激动剂治疗(DA)和手术[17]。由于以前的DA治疗引起的肿瘤纤维化,手术切除可能是具有挑战性的。因此,这项研究调查了术前DA的使用如何影响泌乳素瘤的围手术期治疗和手术结局,旨在确定特定的泌乳素瘤患者亚组是否可以从独家手术干预中获得更大的益处.
方法:我们回顾性分析了2013-2022年在我们机构中,经手术治疗和组织学证实的n=159例鞍区泌乳素腺瘤。临床,分析了放射学和手术特点。进行单变量和多变量分析。
结果:在159例催乳素瘤患者中,83.6%曾接受DA治疗,随后接受手术治疗,而只有16.4%的人接受了独家手术。两组的初始肿瘤体积相似(1.9cm3与1.5cm3,p=0.59)和术前催乳素水平(PRL)相等(199.7µg/l与191.0微克/升,p=0.44)。当患者接受先前的DA治疗时,外科手术花费的时间明显更长(79分钟。vs.70分钟,p=0.0479)。手术后六个月,与未接受治疗的患者相比,接受治疗的患者的PRL明显更高(107g/lvs.8.64µg/,p=0.0009)。此外,未经治疗的微泌乳素瘤缓解了100%,而预处理显示88.75%的缓解率。
结论:当前的研究表明,先前的DA治疗与明显延长的手术有关,较高的复发率和术后PRL水平正常化率较低,特别是在微泌乳素瘤中,并支持垂体学会2023年共识声明的最新建议,该声明主张选择单独手术作为微泌乳素瘤的一线治疗。
BACKGROUND: Prolactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. Due to tumor fibrosis induced by previous DA therapy, surgical removal can be challenging though. Therefore, this study investigates how preoperative DA usage influences perioperative treatment and surgical outcome in prolactinoma and aims to ascertain whether a specific subgroup of prolactinoma patients could derive greater benefit from exclusive surgical intervention.
METHODS: We retrospectively analyzed n = 159 surgically treated and histologically confirmed prolactinomas in the sella region from 2013-2022 in our institution. Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.
RESULTS: Out of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm3 vs. 1.5cm3, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.
CONCLUSIONS: The current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society\'s Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.