A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up.

authors

  • Trouillas Jacqueline
  • Roy Pascal
  • Sturm Nathalie
  • Dantony Emmanuelle
  • Cortet-Rudelli Christine
  • Viennet Gabriel
  • Bonneville Jean-François
  • Assaker Richard
  • Auger Carole
  • Brue Thierry
  • Cornelius Aurélie
  • Dufour Henry
  • Jouanneau Emmanuel
  • François Patrick
  • Galland Françoise
  • Mougel François
  • Chapuis François
  • Villeneuve Laurent
  • Maurage Claude-Alain
  • Figarella-Branger Dominique
  • Raverot Gérald
  • Barlier Anne
  • Bernier M.
  • Bonnet Fabrice
  • Borson-Chazot F.
  • Brassier Gilles
  • Caulet-Maugendre S.
  • Chabre O.
  • Chanson P.
  • Cottier J. F.
  • Delemer B.
  • Delgrange E.
  • Di Tommaso L.
  • Eimer S.
  • Gaillard Sophie
  • Jan M.
  • Girard J. J.
  • Lapras V.
  • Loiseau H.
  • Passagia J. G.
  • Patey M.
  • Penfornis A.
  • Poirier J. Y.
  • Perrin G.
  • Tabarin A.

keywords

  • Classification
  • Pituitary tumour
  • Pituitary adenoma

document type

ART

abstract

Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.

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