The postoperative biological behavior of nonfunctioning pituitary adenomas (NFPAs) is variable. Some residual NFPAs are stable long-term, others grow, and some recur despite complete removal. The usual histological markers of tumor aggressiveness are often similar between recurring, regrowing, and stable tumors, and therefore are not reliable as prognostic parameters. In this study, the clinical utility of proliferation indices (labeling index, Li) based on immunohistochemistry targeted at antigens Ki-67 and High-mobility group A1 (HMGA-1) for prediction of NFPA prognosis was investigated.
Fifty patients with NFPAs were investigated. In each patient, Ki-67 and HMGA-1 Li were evaluated. Based on postoperative magnetic resonance images, patients were classified as tumor-free (18 patients), or harboring a residual tumor (32 patients). The latter group was further subdivided into groups with stable tumor remnants (11 patients) or progressive tumor remnants (21 patients).
The median follow-up period was 8 years. No significant relationship between HMGA-1 Li and residual tumor growth was found. Growing residual tumors showed a trend towards higher Ki-67 Li compared with stable ones (p = 0.104). All tumor remnants with Ki-67 Li above 2.2 % were growing. The relationship between residual tumor growth and Ki-67 Li exceeding the cutoff value of 2.2 % was significant (p = 0.01 in univariate, p = 0.044 in multivariate analysis).
The prognostic significance of the HMGA-1 antigen was not confirmed. In contrast, the Ki-67 Li provides useful and valuable information for the postoperative management of NFPAs. In residual adenomas with a Ki-67 Li above 2.2 %, regrowth should be expected, and these tumors may require shorter intervals of follow-up magnetic resonance imaging (MRI) and/or early adjuvant therapy. Future larger studies are needed to confirm the results of this study.
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This study was supported by a grant from the Scientific Grant Agency of the Ministry of Education of the Slovak Republic and the Slovak Academy of Sciences (VEGA) number 1/1166/10.
Conflict of interest
The authors declare that they have no conflict of interest.
We all search for a histological marker to warn us of the faster growing non-functioning pituitary adenomas after we have resected them. Sadly HMGA1 is not it.
Despite its slight unpredictability, Ki67 Labelling Index remains the best marker. When it is high, then close review of residuals or radiotherapy are indicated. The study does show that complete resection is the best way to protect our patients, and that residuals are likely to regrow, albeit not always.
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Šteňo, A., Bocko, J., Rychlý, B. et al. Nonfunctioning pituitary adenomas: association of Ki-67 and HMGA-1 labeling indices with residual tumor growth. Acta Neurochir 156, 451–461 (2014). https://doi.org/10.1007/s00701-014-1993-0
- Pituitary adenoma
- Residual tumor