• World Neurosurg · Feb 2024

    Multicenter Study

    A novel preoperative score to predict long-term biochemical remission in patients with growth-hormone secreting pituitary adenomas.

    • Salomon Cohen-Cohen, Rima Rindler, Edgar Botello Hernandez, Diane Donegan, Dana Erickson, Fredric B Meyer, John L Atkinson, and Jamie J Van Gompel.
    • Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
    • World Neurosurg. 2024 Feb 1; 182: e882e890e882-e890.

    ObjectiveTranssphenoidal surgery (TSS) is considered the treatment of choice in most patients with growth hormone (GH)-secreting pituitary adenomas. Several preoperative factors have been studied to predict postsurgical remission. Our objective was to design a score that could be used in the preoperative setting to identify patients that will achieve long-term biochemical remission after TSS.MethodsA retrospective analysis of consecutive patients with GH-secreting pituitary adenomas that underwent TSS in our institution from 2000 to 2015 who fulfilled prespecified criteria were included. Logistic regression methods were used to evaluate independent preoperative variables predicting long-term remission. Beta coefficients were used to create a scoring system for clinical practice.ResultsSixty-eight patients were included, with a mean follow-up time of 87 months. Twenty (29%) patients had tumors with a Knosp grade ≥ 3A. Gross-total resection was achieved in 43 (63%) patients. Thirty-three (48%) patients had long-term biochemical remission after TSS. In a multivariate analysis, the following variables were statistically significantly associated with long-term biochemical remission: age, adenoma size (diameter), Knosp grade, GH level, and insulin growth-factor 1index 1 at diagnosis. A score of <3 out of 8 total points was identified as a cutoff associated with long-term remission, with a sensitivity of 91.4% and specificity of 72.7% (AUC 0.867, OR 28.44, 95% CI 6.94-116.47, P = < 0.001).ConclusionsA novel, simple, easy-to-use scoring system was created to identify patients with the highest chances of long-term biochemical remission following TSS. This scale should be prospectively validated in a multicenter study before widespread adoption.Copyright © 2023 Elsevier Inc. All rights reserved.

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