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Predictors of postoperative biochemical remission in acromegaly

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Acromegaly is a rare neuroendocrine condition that can lead to significant morbidity. Despite China’s vast population size, studies on acromegaly remain sparse. This study aimed to investigate the clinical characteristics and predictors of biochemical remission after surgery for acromegaly using the China Acromegaly Patient Association (CAPA) database.

Methods

A retrospective nationwide study was conducted using patient-reported data from CAPA database between 1998 and 2018. The principal component analysis (PCA) and logistic regression analysis were employed to determine independent predictors of biochemical remission at 3 months in patients after surgery.

Results

Of the 546 surgical cases (mean age: 36.8 years; 59.5% females), macroadenomas and invasive tumors (Knosp score 3–4) were 83.9% and 64.1%, respectively. Ninety-five percent of patients were treated with endonasal surgery and 36.8% exhibited biochemical remission at 3-months postoperatively. The following independent predictors of biochemical remission were identified: preoperative growth hormone (GH) levels between 12 and 28 μg/L [odds ratio (OR) = 0.58; 95% confidence interval (CI), 0.37–0.92; p = 0.021], preoperative GH levels > 28 μg/L (OR = 0.55; 95% CI, 0.34–0.88; p = 0.013), macroadenoma (OR = 0.56; 95% CI, 0.32–0.96; p = 0.034), giant adenomas (OR = 0.14; 95% CI, 0.05–0.38; p < 0.001), Knosp score 3–4 (OR = 0.37; 95% CI, 0.24–0.57; p < 0.001), and preoperative medication usage (OR = 2.32; 95% CI, 1.46–3.70; p < 0.001).

Conclusions

In this nationwide study spanning over two decades, we highlight that higher preoperative GH levels, large tumor size, and greater extent of tumor invasiveness are associated with a lower likelihood of biochemical remission at 3-months after surgery, while preoperative medical therapy increases the chance of remission.

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Data availability

To protect the privacy of our patients and due to ethical concerns, only the anonymized data not presented in this article will be made available upon request to any qualified investigators.

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Acknowledgements

The authors would like to thank all the patients and families and their providers who collaborated with the establishment of CAPA database. We are grateful for the collaboration with the Chinese Association of Patients with Acromegaly (CAPA). We also thank Mr. Hao Luo (Warwick Business School, United Kingdom) for creating the China heat-map for the geographic distribution of acromegaly patients

Funding

This work was supported by the funding to Shun Yao through the Chinese Postdoctoral Science Foundation (2019M663271), Clinical Research Project of The East Division (The First affiliated Hospital of Sun Yat-sen University, 2019004) to Wen-Li Chen, and the National Institute on Deafness and Other Communication Disorders (T32DC000038-27) to Leo Zekelman.

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Author notes

  1. Shun Yao and Wen-Li Chen contributed equally to the work.

Authors and Affiliations

  1. Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China

    Shun Yao, Wen-Li Chen, Zhi-Gang Mao & Hai-Jun Wang

  2. Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA

    Shun Yao, Sherwin Tavakol, Michael P. Catalino, Edward R. Laws Jr & Wenya Linda Bi

  3. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Sherwin Tavakol

  4. Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA

    Farhana Akter

  5. Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA

    Michael P. Catalino

  6. Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiaopeng Guo

  7. Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Jie Luo

  8. Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ai-Liang Zeng

  9. Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA, USA

    Leo Zekelman

  10. Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China

    Yong-Hong Zhu

  11. State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, Hubei, China

    Qing-Zhi Wu

Authors
  1. Shun Yao
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  2. Wen-Li Chen
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Contributions

Conception and design: WLC, HJW, and WLB. Drafting the article: SY, ST, and WLB. Acquisition of data: WLC and HJW. Analysis and Interpretation of data: all authors. Critically revising the article: SY, ST, FA, MPC, ERL, WLB, and HJW. Reviewed submitted version of manuscript: all authors. Approved the final version of manuscript on behalf of all authors: HJW. Statistical analysis: SY, ST, and WLB. Graphic visualization: SY. Clinical diagnosis and radiological identification: WLC and ZGM. Administrative/technical/material support: WLC, ZGM, YHZ, and HJW. Study supervision: HJW and WLB.

Corresponding authors

Correspondence to Wenya Linda Bi or Hai-Jun Wang.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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11060_2020_3669_MOESM1_ESM.tiff

The geographic distribution of acromegaly patients in the China Acromegaly Patient Association (CAPA) database between 1998 and 2018, across 23 provinces, 4 autonomous regions, 4 municipalities, and 2 Special Administrative Regions (Hong Kong and Macau) in China. (tiff 5885 KB)

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Yao, S., Chen, WL., Tavakol, S. et al. Predictors of postoperative biochemical remission in acromegaly. J Neurooncol 151, 313–324 (2021). https://doi.org/10.1007/s11060-020-03669-4

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