Comparative mortality in pituitary adenomas subtypes: a tertiary referral center study.

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Pub Date : 2024-10-19 DOI:10.1007/s12020-024-04073-y
Iustin Daniel Toma, Dan Alexandru Niculescu, Simona Andreea Găloiu, Raluca Alexandra Trifănescu, Cătălina Poiană
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Abstract

Purpose: Mortality in pituitary adenomas (PAs) has been extensively compared to general population. However, direct comparisons between PA subtypes are scarce. We aimed to compare mortality in various subtypes of PA (acromegaly, Cushing's disease (CD), macroprolactinomas and non-functioning pituitary macroadenomas (MacroNFPA)), within a single referral center.

Methods: We retrospectively analyzed mortality and survival time in all 962 PAs admitted in our department between 2011 and 2023: acromegaly (n = 306), CD (n = 69), macroprolactinoma (n = 168) and MacroNFPA (n = 419).

Results: Median follow-up was 10.2 (5.2, 15.2) years. The overall survival probability was 90.9% and 78.1% after 10 and 20 years respectively with age at diagnosis as the only significant predictor. There were no significant differences in survival probability between various PA subtypes in the whole cohort. In patients over 45 years of age at diagnosis there was a significant difference in survival probability between the four groups (p = 0.01) in the first 15 years of follow-up. In head-to-head comparisons CD had a significantly higher mortality risk than patients with acromegaly (HR 3.38 [CI 95% 1.07 to 10.60]) even after adjusting for age and sex.

Conclusion: Patients diagnosed with CD after 45 years of age have a significantly lower survival probability than other PA subtypes in the first 15 years of follow-up. All other PA subtypes had a similar survival probability after adjusting for age and sex. Due to advances in medical treatment of hormone secreting tumors, mortality in patients with PAs might increasingly depend more on tumor mass than on hormonal hypersecretion.

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垂体腺瘤亚型的死亡率比较:一项三级转诊中心研究。
目的:垂体腺瘤(PA)的死亡率已被广泛地与普通人群进行比较。然而,对不同亚型垂体腺瘤死亡率的直接比较却很少。我们旨在比较一个转诊中心内不同亚型 PA(肢端肥大症、库欣病(CD)、巨泌乳素瘤和无功能垂体大腺瘤(MacroNFPA))的死亡率:我们回顾性分析了2011年至2023年期间我科收治的所有962例PA患者的死亡率和生存时间:肢端肥大症(306例)、CD(69例)、大泌乳素瘤(168例)和MacroNFPA(419例):中位随访时间为 10.2 (5.2, 15.2) 年。10年和20年后的总生存率分别为90.9%和78.1%,诊断时的年龄是唯一重要的预测因素。在整个队列中,各种 PA 亚型之间的存活率没有明显差异。对于确诊时年龄超过45岁的患者,在最初15年的随访中,四组患者的存活率存在显著差异(P = 0.01)。在头对头比较中,CD患者的死亡风险明显高于肢端肥大症患者(HR 3.38 [CI 95% 1.07至10.60]),即使在调整年龄和性别后也是如此:结论:45岁以后确诊的CD患者在最初15年的随访中存活几率明显低于其他PA亚型。在对年龄和性别进行调整后,所有其他 PA 亚型的生存概率相似。由于激素分泌性肿瘤的医学治疗取得了进展,PA 患者的死亡率可能越来越多地取决于肿瘤的体积,而不是激素分泌过多。
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来源期刊
Endocrine
Endocrine ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
5.40%
发文量
295
审稿时长
1.5 months
期刊介绍: Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
期刊最新文献
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