Analysis Of Relapse-related Factors After Endoscopic Transnasal-sphenoidal Pituitary Tumor Resection

Objective: Surgical resection is the most fundamental and effective treatment for pituitary adenoma.Endoscopic transsphenoidal resection of pituitary adenoma has become the preferred surgical method for pituitary adenoma.However,there is a high recurrence rate after surgery.Recurrent pituitary adenomas are difficult to treat and are harmful to patients.The purpose of this paper is to explore the factors affecting the recurrence of pituitary adenoma after endoscopic transnasal-sphenoidal surgery,so as to guide the formulation of a reasonable comprehensive treatment plan,avoid recurrence after surgery,improve the overall cure rate of pituitary adenoma patients,and maximize the benefits of patients.Methods: Clinical data of 251 patients with pituitary adenoma who underwent endoscopic transnasal sphenoidal pituitary adenoma resection from January 2010 to October 2018 in the Department of Neurosurgery,Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed,Including age,endocrine symptoms and/or signs,post-operative adjuvant therapy,gender,invasiveness of tumors,pituitary apoplexy and/or cystic degeneration,tumor size,visual acuity decline and/or visual field defect,post-operative residual tumors,headache and the results of dynamic observation and review(including imaging examination,hormone levels and changes in clinical symptoms after surgery),Calculate recurrence rate for all factors in parallel Chi-square test analysis and binary logistic regression analysis(P<0.05 difference was statistically significant).Results: A total of 251 patients were enrolled in this study,56 of whom had recurrence after operation,with a recurrence rate of 22.31%.Age,endocrine symptoms and/or signs,post-operative adjuvant therapy,sex,invasiveness of tumors,pituitary apoplexy and/or cystic degeneration,tumor size,visual acuity decline and/or visual field defect,residual tumors and headache were calculated,respectively.The recurrence rate was calculated and compared with Chi-square test,Tumor invasiveness(P<0.01),tumor size(P<0.05),postoperative tumor residual(P<0.01)and postoperative adjuvant therapy(P<0.01)were obtained.The difference was statistically significant,Patients' age,gender,pituitary adenoma and/or cystic changes,visual loss and/or visual field defects,endocrine symptoms and/or signs,and headache P values were >0.05.Logistic regression analysis of all factors showed that the invasiveness of tumors(P=0.018),residual tumors(P=0.002)and adjuvant therapy(P=0.033)had significant differences.The regression coefficients of residual tumors and invasiveness of tumors after operation were more than 0,and the regression coefficients of adjuvant therapy after operation were less than 0.Conclusion: The analysis of this study shows that:1.Postoperative invasiveness,residual tumors and adjuvant therapy are the influencing factors of recurrence after Endoscopic Transnasal-sphenoidal Pituitary Tumor Resection.Postoperative residual tumors and invasiveness are positively correlated with recurrence.Postoperative adjuvant therapy is negatively correlated with recurrence after Endoscopic Transnasal-sphenoidal Pituitary Tumor Resection.2.There was no statistical significance in pituitary tumor stroke and / or cystic degeneration,visual impairment and / or visual field defects,endocrine symptoms and /or signs,sex,age,headache and postoperative recurrence.3.The recurrence rate calculated and Chi-square test analysis showed that the larger the volume,the higher the recurrence rate,the difference was statistically significant.The binary logistic regression analysis showed that there was no significant difference between the size of tumors and the recurrence rate after operation.This study is a single-center data,and the sample size is insufficient.The relationship between the sizeof pituitary adenoma and the recurrence of pituitary adenoma after endoscopic transnasal-sphenoidal pituitary adenoma resection needs to be further explored by more large-scale,multi-center studies.