Elevated risk of recurrence and retreatment for silent pituitary adenomas
Main finding · RecurrenceResult — go to the resultHazard ratio 3.2 95% CI 1.6–7.2Authors' conclusion
Patients undergoing resection of SPAs should be closely monitored for disease recurrence through more frequent clinical follow-up and diagnostic imaging than other adenomas, particularly among patients with STR and younger patients. Several patients can be observed after radiographic recurrence, and the decision to retreat should be individualized. Longitudinal clinical follow-up of SPAs, including an assessment of symptoms, endocrine function, and imaging remains critical.
Study context
- Population
- All patients undergoing resection of SPAs or functional pituitary adenoma (FPAs) by a single high-volume neurosurgeon, 2007–2018, Brigham and Women's Hospital
- Participants
- 88 vs 200
- Exposure
- Silent pituitary adenomas (SPAs) vs functional pituitary adenomas (FPAs) after resection
- SPAn = 88
- FPAn = 200reference
- Outcome
- Recurrence
Methodological detailssingle-surgeon, single-centre
- Single-surgeon
- Single-centre
Main finding
As reported in the abstract
Hazard ratio
3.2
95% CI 1.6–7.2
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Retreatment for recurrenceHigher likelihood with SPA | 2.5 (1.0–6.1) | |
| 0.10.31310Hazard ratio (log scale) |
Tumour diameter
P < 0.001
Gross total resection (GTR)
P < 0.001
Recurrence and retreatment by extent of resection (subset analyses)
- Recurrence and retreatment more likely for subtotally resected SPAs than subtotally resected FPAs; not observed after gross total resection (GTR)
Predictors of recurrence among SPAs (multivariable analysis)
- STR, OR
- 9.3 (95% CI 1.4-64.0)
- Younger age, OR per year
- 0.92 (95% CI 0.88-0.98)
Management of recurred SPAs
- Retreated (repeat surgery n = 11, radiosurgery n = 1)
- 12 of 19 (63.2%)
- Observed
- 7
Recurrence across SPA subtypes
- Similar rates of recurrence across SPA subtypes
Original publication
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