title: A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up.
abstract: Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.
authors: Université Lyon 1, Université de Lyon, Lyon, France. jacqueline.trouillas@univ-lyon1.fr
authors: Jacqueline
authors: J
authors: Trouillas
authors: Pascal
authors: P
authors: Roy
authors: Nathalie
authors: N
authors: Sturm
authors: Emmanuelle
authors: E
authors: Dantony
authors: Christine
authors: C
authors: Cortet-Rudelli
authors: Gabriel
authors: G
authors: Viennet
authors: Jean-François
authors: JF
authors: Bonneville
authors: Richard
authors: R
authors: Assaker
authors: Carole
authors: C
authors: Auger
authors: Thierry
authors: T
authors: Brue
authors: Aurélie
authors: A
authors: Cornelius
authors: Henry
authors: H
authors: Dufour
authors: Emmanuel
authors: E
authors: Jouanneau
authors: Patrick
authors: P
authors: François
authors: Françoise
authors: F
authors: Galland
authors: François
authors: F
authors: Mougel
authors: François
authors: F
authors: Chapuis
authors: Laurent
authors: L
authors: Villeneuve
authors: Claude-Alain
authors: CA
authors: Maurage
authors: Dominique
authors: D
authors: Figarella-Branger
authors: Gérald
authors: G
authors: Raverot
authors: A
authors: A
authors: Barlier
authors: M
authors: M
authors: Bernier
authors: F
authors: F
authors: Bonnet
authors: F
authors: F
authors: Borson-Chazot
authors: G
authors: G
authors: Brassier
authors: S
authors: S
authors: Caulet-Maugendre
authors: O
authors: O
authors: Chabre
authors: P
authors: P
authors: Chanson
authors: J F
authors: JF
authors: Cottier
authors: B
authors: B
authors: Delemer
authors: E
authors: E
authors: Delgrange
authors: L
authors: L
authors: Di Tommaso
authors: S
authors: S
authors: Eimer
authors: S
authors: S
authors: Gaillard
authors: M
authors: M
authors: Jan
authors: J J
authors: JJ
authors: Girard
authors: V
authors: V
authors: Lapras
authors: H
authors: H
authors: Loiseau
authors: J G
authors: JG
authors: Passagia
authors: M
authors: M
authors: Patey
authors: A
authors: A
authors: Penfornis
authors: J Y
authors: JY
authors: Poirier
authors: G
authors: G
authors: Perrin
authors: A
authors: A
authors: Tabarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology* / Q000648:ultrastructure; D010911:Pituitary Neoplasms / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D055815:Young Adult