Faculty of Medicine
Library of the School of Health Sciences

2023-06-29

2023

Stefanidis Petros

Δαμιανός Σακάς, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σταμάτιος Θεοχάρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευανθία Κασσή, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Άννα Αγγελούση, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Στέφανος Κορφιάς, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Στυλιανός Γκατζώνης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χάρις Μπουργιώτη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ

Προγνωστικοί δείκτες (κλινικοί και ιστοπαθολογικοί) υποτροπής αδενωμάτων υπόφυσης και μετεγχειρητικές επιπλοκές διασφηνοειδικής προσπέλασης

Greek

Prognostic factors (clinical and histopathological) of recurrence of pituitary adenomas and post-operative complications of transsphenoidal approach

Background: The aim of the current study is to evaluate the immunohistochemical expression of Ki-67, CD-56, Cyclin-D1 and E-Cadherin in PAs and to study the possible association with the clinical presentation of PAs, tumor size and invasiveness as well as with the risk of recurrence. In addition, post-surgical complications were analyzed and compared with previous published literature.
Materials and Methods: Ninety four patients who underwent transsphenoidal excision of PAs were included in our study. Paraffin embedded tissue samples were immunohistochemically analysed for the expression of Cyclin-D1, CD-56, E-Cadherin and Ki-67. One hundred ten endoscopic procedures were performed in 94 patients with PAs by the same neurosurgical team of a tertiary center during the period 2014–2019. Post-surgical complications were analyzed and compared with data published during the last 5 years in the PubMed and Cochrane databases by performing a systematic review and meta-analysis of the literature.
Results: The expression of Cyclin-D1 and Ki-67 index levels were positively correlated with the size (p<0.001, r= 0.56 and p<0.001, r=0.43 respectively), the recurrence (p<0.001, r=0.46 and p=0.007 r=0.3 respectively), the extrasellar extension (p<0.001, r=0.48 and p=<0.001, r=0.4 respectively) and the cavernous sinus invasion of (p<0.001, r=0.39 and p<0.001, r=0.3 respectively). No correlation was found between CD-56 and E-Cadherin with size, invasiveness and recurrence of pituitary adenomas.
The overall complication rate in our series was 23.4%. Diabetes insipidus (DI) and intraoperative cerebrospinal fluid (CSF) leakage were the commonest complications (12.8%), followed by postoperative hypopituitarism (9.2%) and hematoma (8.5%) during the follow-up of 2.15 ± 1.4 years. Syndrome of inappropriate antidiuretic hormone secretion, meningitis, deep vein thrombosis, and hyposmia were rare (< 3%). Postoperative hypopituitarism was significantly associated with incidence of hematoma. No statistically significant association was found between PAs Hardy and Knosp scale grading or between patients’ characteristics with the occurrence of postoperative complications. Our meta-analysis including nine studies found no significant differences comparing the complications of endoscopic versus microscopic surgery.
Conclusion: Cyclin-D1 and Ki-67 are promising immunohistochemical markers in predicting the invasive behavior and recurrence of PAs in contrast to E-Cadherin and CD-56 which didn’t seem to be associated with PAs behavior post-surgery. However larger studies are required in order to establish their role in the routine evaluation of PAs. The endoscopic approach is safe when performed by experienced surgical teams. CSF leakage and DI were the commonest complications in our series; however, confirmation by larger studies is required. Meta-analysis showed no statistically significant differences in complication rates comparing endoscopic versus microscopic surgery.

Health Sciences

Pituitary, Recurrence, Adenoma, Complications, Factors

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Yes

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https://pergamos.lib.uoa.gr/uoa/dl/object/3332238