Treatment Strategy Selection And Analysis Of Prognosis Related Factors Of Pituitary Adenoma

Objective:The individualized treatment strategy of pituitary adenoma were analyzed to explore the prognostic related factors for pituitary adenoma.Methods:The clinical characteristics,curative effect,complications and prognostic factors of 495 inpatient pituitary adenoma with operation,gamma knife and combined treatment in Neurosurgery Department,Sichuan Provincial People's Hospital in recent 4 years were analyzed retrospectively.Results:(1)Special subtypes and treatment methods:?tumor cyst:93 cases,all received operations.?tumor stroke:54 cases,all received operations.?optic pathway compression:360 cases,93.89%patients received operation,the diameter distribution was significantly different(P=0.006).?invasive tumors:149 cases,86.58%patients received operation,the diameter distribution was significantly different(P=0.002).?common pituitary adenoma:102 cases,54.90%of them have gamma knife surgery,31.37%received operation,there was no difference in diameter distribution.?A total of 7/4 patients with PRL adenoma and 4/2 cases with GH adenoma received surgery/gamma knife after drug treatment.(2)Therapeutic effects and complications:?Surgical treatment:totally 416 cases,the visual impairment(63.94%),macroadenoma(46.63%),tumor stroke(12.98%),tumor cyst(22.36%),optic pathway compression(81.20%)were very common.And the postoperative visual improvement,endocrine remission and complications were 56.39%,75.14%and 33.89%,respectively.? Gamma knife therapy:in 47 cases.There were high proportion of the microadenoma and small pituitary adenoma(44.68%)and non-visual compression(70.21%).For those followed-up more than 1 year,the tumor effective control was 96.77%,visual improvement 76.92%,endocrine remission 83.33%,and the complication ratio was 10.64%.? Combined therapy:in 32 cases with high proportion of cavernous sinus invasion(40.62%),invasive tumors(43.75%).Those followed-up more than 1 year,the tumor effective control ratio was 72.22%,visual improvement ratio 83.33%,endocrine remission ratio 80.00%and complications ratio 9.3 8%respectively.(3)Contrastive analysis:there was no significant difference in visual improvement and endocrine remission rate among the three groups.The tumor control rate of gamma knife group was better than that of combined treatment group.The complication rates after combined treatment and gamma knife treatment were lower than that after operation(P=0.010,0.004).(4)Prognostic factors:?tumor control rate:significantly correlated with tumor diameter and surgical intervention,?hormone improvement rate:there was no significant correlation factor.?Independent influencing factors of postoperative visual impairment recovery were the patient age(OR=0.420;95%CI:0.269?0.655),tumor volume(OR=0.479;95%CI:0.329?0.696)and sellar floor bone destruction(OR=0.357;95%CI:0.180?0.708).?Independent risk factors of postoperative pituitary dysfunction were the preoperative hypopituitarism(OR=2.474;95%CI:1.321?4.632)and tumor stroke(OR=2.284;95%CI:1.166?4.472).Conclusion:(1)Operation,gamma knife and combined treatment can effectively control tumor volume,reduce high secreting hormone level and improve visual impairment.(2)Combined treatment has advantages in improving surgical safety,suitable for refractory and invasive pituitary adenoma.(3)The individualized comprehensive treatment based on the visual disturbances,subtype of neuroimaging,types of adenoma and tumor volume of patients is advocated.(4)Advanced age,large tumor volume and sellar floor bone destruction,preoperative pituitary dysfunction and tumor stroke,as well as types of surgical intervention are the important factors affecting prognosis.