Predictors of progression after surgery in non-functioning pituitary macroadenomas: a Spanish multicenter study.
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Biagetti Betina, Cardona-Arias Andres, Torre Edelmiro Menéndez, Aulinas Anna, Ruz-Caracuel Ignacio, Centeno Rogelio García, González Laura, Echarri Ana Irigaray, Rodríguez María Dolores Moure, Paja Miguel, Guerrero-Pérez Fernando, Castaño Justo P, García María Dolores Ollero, Novo-Rodríguez Cristina, Tenorio-Jimenéz Carmen, Villar-Taibo Rocío, Bernabéu Ignacio, Díaz-López Everardo, Calatayud María, Alvarez-Escola Cristina, Rojas-Marcos Patricia Martín, Recio-Córdova José María, Lozano-Aida Claudia, Roca Queralt Asla, Aviles María Dolores, Mezquita Elena López, Argueso María Fernández, Molero Inmaculada González, Alberoa Iban, Idrobo Cindy, Achote Estefanía, Martínez-Sáez Elena, Marazuela Mónica, Puig-Domingo Manel, Hanzu Felicia, Araujo-Castro Marta
Аннотация
METHODS: We conducted a retrospective multicenter study including 472 patients with NFPAs > 1 cm from 17 Spanish hospitals (416 surgical, 56 conservative management). Tumor progression was defined as > 20% increase in size, >2 mm growth on imaging, or new/worsening clinical symptoms. Kaplan-Meier analysis was used to estimate PFS for both groups and independent predictors of progression were assessed using Cox proportional hazards regression in the surgical cohort.
RESULTS: During a median follow-up of 7.9 years (range: 5.0-46.9), tumor progression occurred in 67 patients (14.2%). Most progression 29/67 (89.6%) events occurred within the first 15 years of follow-up. Multivariate analysis identified residual tumor (HR = 5.1; 95% CI: 2.2-11.9; p < 0.01) and aggressive histopathology (HR = 2.1; 95% CI: 1.1-3.8; p = 0.02) as significant independent predictors of progression. Neither gender, age, radiotherapy nor cabergoline treatment significantly altered progression risk in the multivariate model.
CONCLUSION: NFPAs show a gradual risk of progression over time, particularly during the first 15 years post-diagnosis. Postoperative residual tumor and aggressive histopathological features are the strongest predictors of progression, highlighting the importance of maximal safe resection when feasible and detailed histopathological assessment for risk stratification. These findings support long-term surveillance for high-risk patients.