Preoperative Somatostatin Analogs Treatment For Acromegaly Patients With Pituitary Macroadenomas:A Meta-analysis

Objective:To evaluate the surgical effect of preoperative somatostatin analogs treatment for acromegaly patients with growth hormone-secreting pituitary macroadenomas systematically via a meta-analysis,so as to provide a reference for the clinical treatment and further studies of acromegaly patients.Methods:Pub Med,EMBASE,Cochrane Library,and Web of Science were used to search for clinical studies of preoperative somatostatin analogs treatment for acromegaly patients with GH-secreting pituitary adenomas published before December 2018.After screening the literatures according to the inclusion criteria and exclusion criteria,the quality of the included literatures was assessed with the Cochrane collaboration's tool for assessing risk of basis,the relevant data in the included literatures was extracted and the Review Manager5.3 software was used for meta analysis.Results:Five articles involving four randomized controlled trials were finally included,a total of 250 acromegaly patients with GH-secreting pituitary macroadenomas was randomly assigned to the experimental group or the control group,of which 125 patients in the experimental group received preoperative somatostatin analogs treatment+endonasal transsphenoidal surgery,and 125 patients in the control group received endonasal transsphenoidal surgery.The results of meta analysis showed that the biochemical remission rates of the experimental group were significantly higher than those of the control group in terms of the short-term(3~4 months)biochemical remission after surgery,and the difference was statistically significant(RR = 2.44,95% CI:1.53-3.89,P = 0.0002).In terms of the long-term(? 1 year)biochemical remission after surgery,no statistically significant difference appeared between the two groups(RR = 1.98,95%CI:0.95-4.12,P = 0.07).Subgroup analysis showed that the postoperative short-term biochemical remission rates of the experimental groups were both significantly higher than those of the control groups after the preoperative long-acting octreotide or lanreotide treatment(RR = 3.16,95%CI:1.28-7.82,P = 0.01 and RR = 2.17,95%CI:1.26-3.75,P = 0.005,respectively),there was no difference between these subgroups.The incidence of surgical complications did not differ between the experimental group and the control group.Conclusion:For acromegaly patients with GH-secreting pituitary macroadenomas,the preoperative somatostatin analogs treatment was beneficial to their postoperative short-term biochemical remission,but the benefit to their postoperative long-term biochemical remission was unproven.Limited by the small number of the relevant randomized controlled trials published at present,so further studies were required.