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Usefulness of a clinicopathological classification in predicting treatment-related outcomes and multimodal therapeutic approaches in pituitary adenoma patients: retrospective analysis on a Portuguese cohort of 129 patients from a tertiary pituitary center

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Abstract

Purpose

A clinicopathological classification has been designed to predict recurrence/progression in patients with pituitary adenomas (PAs). We aimed to study its usefulness in predicting PAs that will have a challenging disease course and may require more often complex multimodal and multiple therapeutic approaches.

Methods

Retrospective analysis of 129 patients with PAs operated in our institution between 2001 and 2020 (84 non-clinically functioning PAs, 32 acromegaly, 9 Cushing’s disease, 2 prolactinomas and 2 thyrotropinomas). Grading was based on invasion and proliferation: 1a (non-invasive, non-proliferative; n = 59), 1b (non-invasive, proliferative; n = 17), 2a (invasive, non-proliferative; n = 38), and 2b (invasive, proliferative; n = 15).

Results

Of the 129 patients, 68 (52.7%) were females, and the mean age at diagnosis was 53.7 ± 15.4 years. The mean follow-up duration was 93.1 ± 61.8 months. Grade 2b PAs when compared to other grades (2b-2a-1b-1a) had significantly higher rates of persistent tumor remnant within 1-year after operation (93–78-18–30%; p < 0.001), active disease at last follow-up (40–27-12–10%; p = 0.004), re-operation (27–16-0–5%; p = 0.023), irradiation (53–38-12–7%; p < 0.001), multimodal treatment (67–49-18–25%; p = 0.003), multiple treatment (33–27-6–9%; p = 0.017). Patients with grade 2b PAs also required a higher mean number of treatments (2.6–2.1–1.2–1.4; p < 0.001).

Conclusions

This clinicopathological classification appears to be a useful grading system to identify PAs that may be more refractory and more often require complex multimodal and multiple therapeutic approaches. Invasive PAs, especially grade 2b tumors, may be more likely to need complex treatment approach, including radiotherapy, and may display higher rates of active disease at last follow-up, despite receiving higher number of treatments.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

P.M. was supported by the Neuroendocrine Tumor Research Foundation (NETRF).

Author information

Author notes

  1. Carolina Peixe and Maria Inês Alexandre have contributed equally to this work.

Authors and Affiliations

  1. Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal

    Carolina Peixe, Maria Inês Alexandre, Ana Raquel Gomes, Ema Nobre, Ana Luísa Silva, Maria João Bugalho & Pedro Marques

  2. Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

    Ana Raquel Gomes, Ema Nobre, Ana Luísa Silva & Maria João Bugalho

  3. Pathology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal

    Tiago Oliveira & Dolores López-Presa

  4. Neurosurgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal

    Cláudia C. Faria & José Miguens

  5. Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Cláudia C. Faria

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Contributions

CP and MIA collected and analysed the data, and wrote the manuscript; ARG, EN, ALS., TO, DL-P, CCF, JM and MJB provided critical input; PM designed the study, provided critical input, collected and analysed the data, and wrote the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Pedro Marques.

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The authors declare no competing interests.

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This study was approved by the local Ethics Committee (No. 400/21).

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Peixe, C., Alexandre, M.I., Gomes, A.R. et al. Usefulness of a clinicopathological classification in predicting treatment-related outcomes and multimodal therapeutic approaches in pituitary adenoma patients: retrospective analysis on a Portuguese cohort of 129 patients from a tertiary pituitary center. Pituitary 26, 352–363 (2023). https://doi.org/10.1007/s11102-023-01319-2

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