• Matthew C Findlay, Sam Tenhoeve, Jeremiah Alt, Robert C Rennert, William T Couldwell, James Evans, Sarah Collopy, Won Kim, William Delery, Donato Pacione, Albert Kim, Julie M Silverstein, Michael R Chicoine, Paul Gardner, Lauren Rotman, YuenKevin C JKCJDepartment of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA., Garni Barkhoudarian, Juan Fernandez-Miranda, Carolina Benjamin, Varun R Kshettry, Gabriel Zada, Jamie Van Gompel, Michael P Catalino, Andrew S Little, and Michael Karsy.
• Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City , Utah , USA.
• Neurosurgery. 2024 Oct 1; 95 (4): 761769761-769.

Background And ObjectiveCushing disease (CD) affects mortality and quality of life along with limited long-term remission, underscoring the need to better identify recurrence risk. The identification of surgical or imaging predictors for CD remission after transsphenoidal surgery has yielded some inconsistent results and has been limited by single-center, single-surgeon, or meta-analyses studies. We sought to evaluate the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database of academic US pituitary centers to assess whether robust nonhormonal recurrence predictors could be elucidated.MethodsPatients with treated CD from 2011 to 2023 were included. The perioperative and long-term characteristics of CD patients with and without recurrence were assessed using univariable and multivariable analyses.ResultsOf 383 patients with CD from 26 surgeons achieving postoperative remission, 288 (75.2%) maintained remission at last follow-up while 95 (24.8%) showed recurrence (median time to recurrence 9.99 ± 1.34 years). Patients with recurrence required longer postoperative hospital stays (5 ± 3 vs 4 ± 2 days, P = .002), had larger average tumor volumes (1.76 ± 2.53 cm 3 vs 0.49 ± 1.17 cm 3 , P = .0001), and more often previously failed prior treatment (31.1% vs 14.9%, P = .001) mostly being prior surgery. Multivariable hazard prediction models for tumor recurrence found younger age (odds ratio [OR] = 0.95, P = .002) and Knosp grade of 0 (OR = 0.09, reference Knosp grade 4, P = .03) to be protective against recurrence. Comparison of Knosp grade 0 to 2 vs 3 to 4 showed that lower grades had reduced risk of recurrence (OR = 0.27, P = .04). Other factors such as length of stay, surgeon experience, prior tumor treatment, and Knosp grades 1, 2, or 3 failed to reach levels of statistical significance in multivariable analysis.ConclusionThis multicenter study centers suggests that the strongest predictors of recurrence include tumor size/invasion and age. This insight can help with patient counseling and prognostication. Long-term follow-up is necessary for patients, and early treatment of small tumors may improve outcomes.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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