Therapeutic Efficacy And Prognosis Factors Analysis Of Invasive Pituitary Adeomas Underdoing Surgery

OBJECTIVE:This retrospective study aimed to investigate the therapeutic effect after surgery and analyze the correlative prognostic factors.METHODS:From 2010 to 2015,92 patients diagnosed with invasive pituitary adenomas were surgically treated within our neurosurgery departmentThe clinical and radiology data were reviewed,as well as the follow-up records which were used to evaluate the therapeutic efficacy after surgery. Univariate and multivariate logistic analyzes were performed to identify the relationship between various factors(age, sex, preoperative hormone, visual functional,invasion cavernous sinus,circumvolutio arteria carotis interna,oppress third ventricle of cerebrum, bone destruction, destroy sphenoid sinus,tumor size, quality, type, apoplexy, operative approach, resection and adjuvant therapy) and outcome.RESULT:Among the 92 patients,62 cases were underwent trans-sphenoid surgery,28 transcranial surgery and 2 trans-sphenoid combined with transcranial operation.63 patients improved(68.5%),26 alleviated and 3 worsen.42 patients had achieved gross total resection(45.7%),24 subtotal resection and 26 partial resection.The post-operative complications occurred in 44 patients(47.8%),19 major complications and 38 minor complications.31eases received post-operation adjunctive therapy.Recurrence during the follow-up occurred in 32 patients(34.8%).The average recurrence-free survival was 28 months for a median follow-up of 25 months.The clinical symptoms improved in the patients with gross total resection compared with the patients without subtotal resection(0.023).The higher resection in the patients without invasion cavernous sinus and circumvolutio arteria carotis interna compared with the patients with invasion cavernous sinus and circumvolutio arteria carotis interna(p=0.012 and p=0.003).The post-operative complications more frequently occurred in the patients with preperative visual neurological deficits compared with the patients without visual neurological deficits(P=0.031).The Univariate analyzes identified aignificant relationship between the recurrence and preoperative high hormone level,invasion cavernous sinus,circumvolutio arteria carotis interna,tumor type,resection and adjuvant therapy(P=0.007, P=0.046, P=0.047, P=0.024, P=0.014 and p=0.003,respectively).When the multivariate logistic analyzes were performed,only invasion cavernous sinus and adjuvant therapy remained significant for the recurrence(P=0.027 and P=0.001).CONCLUSION:1.The surgery can effectively remove tumor, clinical symptoms improved significantly;2.The operaton is difficulty to subtotal resection, postoperative residual is given priority to the cavernous sinus;3.Many factors contribute to the postoperative recurrence of invasive pituitary adeomas.operation is major therapy.The patient and invasive factors should be considered,and follow the principle of individualization.4.Postoperative adjunctive therapy can prevent or reduce the invasive pituitary adenomas recurrence.