Abstract
A subset of large non-functioning pituitary adenomas (lNFPA) and giant non-functioning pituitary adenomas (gNFPA) undergoes early progression/recurrence (P/R) after surgery. This study revealed the clinical and image predictors of P/R in lNFPA and gNFPA, with emphasis on solid tumor size. This retrospective study investigated the preoperative MR imaging features for the prediction of P/R in lNFPA (> 3 cm) and gNFPA (> 4 cm). Only the patients with a complete preoperative brain MRI and undergone postoperative MRI follow-ups for more than 1 year were included. From November 2010 to December 2020, a total of 34 patients diagnosed with lNFPA and gNFPA were included (median follow-up time 47.6 months) in this study. A total of twenty-three (23/34, 67.6%) patients had P/R, and the median time to P/R is 25.2 months. Solid tumor diameter (STD), solid tumor volume (STV), and extent of resection are associated with P/R (p < 0.05). Multivariate analysis showed large STV is a risk factor for P/R (p < 0.05) with a hazard ratio of 30.79. The cutoff points of STD and STV for prediction of P/R are 26 mm and 7.6 cm3, with AUCs of 0.78 and 0.79 respectively. Kaplan–Meier analysis of tumor P/R trends showed that patients with larger STD and STV exhibited shorter progression-free survival (p < 0.05). For lNFPA and gNFPA, preoperative STD and STV are significant predictors of P/R. The results offer objective and valuable information for treatment planning in this subgroup.
Highlights
Pituitary adenomas (PA) constitute 10–25% of all intracranial neoplasms [12]
This study evaluated the preoperative clinical and MR imaging characteristics for the prediction of P/R in large non-functioning pituitary adenomas (lNFPA) and giant non-functioning pituitary adenomas (gNFPA), with emphasis on solid tumor diameter (STD) and solid tumor volume (STV)
Large preoperative Solid tumor diameter (STD) and STV are more frequently observed in the P/R group (p < 0.05) (Figs. 2 and 3)
Summary
A subgroup of these tumors challenging to manage are those that can be classified as large and giant PA [4, 8]. Large and giant PA that grow beyond the sellar are always difficult to manage surgically because of the surrounding important neurovascular structures and a greater risk of complications [4, 8, 35]. Large and giant PA comprise about 6–10% of all pituitary tumors [12, 44]. Most of them are clinically non-functioning pituitary adenomas (NFPA) and occur predominantly in males [12, 17, 44]. Partial or total hypopituitarism is observed in some patients due to tumor compression of the normal pituitary gland [17]. More than 90% of NFPA are diagnosed as benign adenomas
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