Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis
Authors' conclusion
This systematic review and patient-level meta-analysis provides a robust prognostication of surgically treated NFPA. We reinforce current guidelines stating that GTR should be the standard of surgical resection. Postoperative radiotherapy is of considerable benefit, especially for patients with STR. Surgical approach does not significantly affect long-term prognosis.
Study context
- Population
- Patients with surgically resected nonfunctioning pituitary adenomas (NFPA); studies from PubMed, EMBASE and Web of Science to 6 November 2022
- Participants
- 3,941 patients11 studies
- Comparison
- Gross total resection (GTR) vs subtotal resection (STR); postoperative radiotherapy vs none; Endoscopic endonasal (EES) vs microscopic transsphenoidal (MTS)
- Outcome
- Long-term progression-free survival (PFS)
Methodological detailsone-stage and two-stage meta-analysis, Kaplan-Meier curves digitized to obtain individual patient data (IPD), indirect analysis of single-arm data (EES vs MTS)
- One-stage and two-stage meta-analysis
- Kaplan-Meier curves digitized to obtain IPD
- Indirect analysis of single-arm data (EES vs MTS)
Pooled result
As reported in the abstract
PFS
Estimate (95% CI)P value
Postoperative radiotherapyvs No radiotherapyradiotherapy significantly improved PFS
shared-frailty HR 0.20(0.15–0.26)
P < 0.001EESvs MTSsimilar PFS
indirect HR 1.09(0.92–1.30)
P = 0.301- GTR vs STR · progression-free survival (PFS) significantly lower in STR than GTR
- shared-frailty HR 0.32 (95% CI 0.27–0.39); P < 0.001
Further pooled results
| Outcome | Shared-frailty HR (95% CI) | P value | |
|---|---|---|---|
| PFS, subgroup with STRPostoperative radiotherapyvs No radiotherapy | 0.12 (0.08–0.18) | P < 0.001 | |
| 0.050.21520Shared-frailty HR (log scale) |
Original publication
Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis. Pituitary. Published 30 June 2023. doi:10.
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