Acta Neuropathologica

, Volume 126, Issue 1, pp 123–135 | Cite as

A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case–control study of 410 patients with 8 years post-operative follow-up

  • Jacqueline TrouillasEmail author
  • Pascal Roy
  • Nathalie Sturm
  • Emmanuelle Dantony
  • Christine Cortet-Rudelli
  • Gabriel Viennet
  • Jean-François Bonneville
  • Richard Assaker
  • Carole Auger
  • Thierry Brue
  • Aurélie Cornelius
  • Henry Dufour
  • Emmanuel Jouanneau
  • Patrick François
  • Françoise Galland
  • François Mougel
  • François Chapuis
  • Laurent Villeneuve
  • Claude-Alain Maurage
  • Dominique Figarella-Branger
  • Gérald Raverot
  • The members of HYPOPRONOS
Original Paper


Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case–control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.


Classification Pituitary tumour Pituitary adenoma 



We thank Emily Witty from Angloscribe for help with the translation into English, A. Reynaud for her excellent technical assistance, P. Gérardi for typing the manuscript, Dr David Forman and Dr Alexandre Vasiljevic for helpful criticisms. Co-authors of HYPOPRONOS are Barlier A., Bernier M., Bonnet F., Borson-Chazot F., Brassier G., Caulet-Maugendre S., Chabre O., Chanson P., Cottier JF., Delemer B., Delgrange E., Di Tommaso L., Eimer S., Gaillard S., Jan M., Girard JJ., Lapras V., Loiseau H., Passagia JG., Patey M., Penfornis A., Poirier JY., Perrin G., Tabarin A. This work was supported by grants from the Ministère de la Santé (Programme Hospitalier de Recherche Clinique National no 27-43, HYPOPRONOS) and research contracts with the Institut National de la Santé et de la Recherche Médicale and the Ligue Contre le Cancer Rhône-Alpes.

Conflict of interest

The authors have nothing to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jacqueline Trouillas
    • 1
    • 28
    • 29
    Email author
  • Pascal Roy
    • 1
    • 2
    • 4
    • 5
  • Nathalie Sturm
    • 9
  • Emmanuelle Dantony
    • 1
    • 2
    • 4
    • 5
  • Christine Cortet-Rudelli
    • 10
    • 11
    • 12
  • Gabriel Viennet
    • 16
  • Jean-François Bonneville
    • 17
  • Richard Assaker
    • 10
    • 11
    • 13
  • Carole Auger
    • 1
    • 3
  • Thierry Brue
    • 19
    • 20
    • 21
    • 22
  • Aurélie Cornelius
    • 10
    • 11
  • Henry Dufour
    • 19
    • 23
  • Emmanuel Jouanneau
    • 1
    • 2
    • 3
    • 6
  • Patrick François
    • 25
  • Françoise Galland
    • 26
    • 27
  • François Mougel
    • 18
  • François Chapuis
    • 1
    • 2
    • 7
  • Laurent Villeneuve
    • 1
    • 2
    • 7
  • Claude-Alain Maurage
    • 10
    • 11
    • 14
    • 15
  • Dominique Figarella-Branger
    • 19
    • 24
  • Gérald Raverot
    • 1
    • 2
    • 3
    • 8
  • The members of HYPOPRONOS
  1. 1.Université Lyon 1, Université de LyonLyonFrance
  2. 2.Hospices Civils de LyonLyonFrance
  3. 3.INSERM, UMR-S1028, Lyon Neuroscience Research CenterOncoflam TeamFrance
  4. 4.Service de Biostatistique, Hospices Civils de LyonLyonFrance
  5. 5.CNRS; UMR 5558, Equipe Biostatistique SantéPierre-BéniteFrance
  6. 6.Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de LyonBronFrance
  7. 7.Pôle Information Médicale, Unité de Recherche Clinique, Hospices Civils de LyonLyonFrance
  8. 8.Fédération d’Endocrinologie, Groupement Hospitalier Est, Hospices Civils de LyonBronFrance
  9. 9.Département d’Anatomie et de Cytologie PathologiquesCentre Hospitalo-Universitaire de GrenobleGrenobleFrance
  10. 10.Université Lille Nord de FranceLilleFrance
  11. 11.Centre Hospitalo-Universitaire de LilleLilleFrance
  12. 12.Département d’EndocrinologieCentre Hospitalo-Universitaire de LilleLilleFrance
  13. 13.Service de Neurochirurgie, Centre Hospitalo-Universitaire de LilleLilleFrance
  14. 14.INSERM U837LilleFrance
  15. 15.Laboratoire d’Anatomie Pathologique, Centre Hospitalo-Universitaire de LilleLilleFrance
  16. 16.Laboratoire d’Anatomie et Cytologie PathologiquesHôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de BesançonBesançonFrance
  17. 17.Service de Radiologie, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de BesançonBesançonFrance
  18. 18.Service d’Endocrinologie, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de BesançonBesançonFrance
  19. 19.Aix-Marseille UniversitéMarseilleFrance
  20. 20.Service d’Endocrinologie, Diabète et Maladies Métaboliques, Hôpital de la Timone, Assistance-Publique Hôpitaux de MarseilleMarseilleFrance
  21. 21.Unité Mixte de Recherche 7286, Faculté de Médecine de Marseille, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche ScientifiqueAix-Marseille UniversitéMarseilleFrance
  22. 22.Centre de Référence des Maladies Rares d’Origine Hypophysaire, Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la TimoneMarseilleFrance
  23. 23.Département de NeurochirurgieHôpital de la Timone, Assistance-Publique Hôpitaux de MarseilleMarseilleFrance
  24. 24.Service d’Anatomie Pathologique et de Neuropathologie, Hôpital de la Timone, Assistance-Publique Hôpitaux de MarseilleMarseilleFrance
  25. 25.Service de Neurochirurgie, Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de ToursToursFrance
  26. 26.Université Rennes 1RennesFrance
  27. 27.Service d’Endocrinologie Diabétologie, Hôpital SudRennesFrance
  28. 28.Centre de Pathologie EstHospices Civils de LyonLyonFrance
  29. 29.INSERM, UMR-S1028, Lyon Neuroscience Research Center, Oncoflam TeamLyon Cedex 08France

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