Alice Ryba, Diego Gonzalez Lopez, Roman Rotermund, Jörg Flitsch
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Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Out of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm<sup>3</sup> vs. 1.5cm<sup>3</sup>, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.</p><p><strong>Conclusion: </strong>The current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society's Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291524/pdf/","citationCount":"0","resultStr":"{\"title\":\"Preoperative treatment with dopamine agonist therapy influences surgical outcome in prolactinoma: a retrospective single-center on 159 patients.\",\"authors\":\"Alice Ryba, Diego Gonzalez Lopez, Roman Rotermund, Jörg Flitsch\",\"doi\":\"10.1007/s00701-024-06198-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Prolactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. 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引用次数: 0
摘要
导言:催乳素瘤是最常见的垂体腺瘤,目前的治疗方法包括多巴胺受体激动剂(DA)治疗和特定病例的手术治疗[17]。由于之前的多巴胺治疗导致肿瘤纤维化,手术切除可能具有挑战性。因此,本研究探讨了术前使用多巴胺如何影响泌乳素瘤的围手术期治疗和手术结果,并旨在确定特定亚组的泌乳素瘤患者是否能从完全的手术干预中获得更大的益处:我们回顾性分析了本院2013-2022年期间经手术治疗和组织学确诊的159例蝶鞍区泌乳素瘤。分析了临床、放射学和手术特征。进行了单变量和多变量分析:在159例泌乳素瘤患者中,83.6%的患者在接受DA治疗后接受了手术,只有16.4%的患者只接受了手术。两组患者的初始肿瘤体积相似(1.9 立方厘米对 1.5 立方厘米,P = 0.59),术前泌乳素水平(PRL)相同(199.7 微克/升对 191.0 微克/升,P = 0.44)。如果患者事先接受了 DA 治疗,手术时间会明显延长(79 分钟对 70 分钟,p = 0.0479)。手术六个月后,接受过预处理的患者显示 PRL 明显高于未接受预处理的患者(107 克/升 vs. 8.64 微克/升,p = 0.0009)。此外,未经治疗的微泌乳素瘤的缓解率为100%,而经预处理的缓解率为88.75%:目前的研究表明,DA治疗前的手术时间明显更长,复发率更高,术后PRL水平的正常化率更低,尤其是在微泌乳素瘤中,支持垂体协会《2023共识声明》的最新建议,即倾向于选择单纯手术作为微泌乳素瘤的一线疗法。
Preoperative treatment with dopamine agonist therapy influences surgical outcome in prolactinoma: a retrospective single-center on 159 patients.
Introduction: Prolactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. Due to tumor fibrosis induced by previous DA therapy, surgical removal can be challenging though. Therefore, this study investigates how preoperative DA usage influences perioperative treatment and surgical outcome in prolactinoma and aims to ascertain whether a specific subgroup of prolactinoma patients could derive greater benefit from exclusive surgical intervention.
Methods: We retrospectively analyzed n = 159 surgically treated and histologically confirmed prolactinomas in the sella region from 2013-2022 in our institution. Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.
Results: Out of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm3 vs. 1.5cm3, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.
Conclusion: The current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society's Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.
期刊介绍:
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.