title: Comparison of the effects of primary somatostatin analogue therapy and pituitary adenomectomy on survival in patients with acromegaly: a retrospective cohort study.
abstract: OBJECTIVE
  Acromegalic patients have an increased risk of mortality. The objective of this study was to compare the effect of different therapies for acromegaly on mortality.
  
  
  METHODS
  The mortality rate of 438 consecutive acromegalic patients was compared with that of the general population using the standardized mortality ratio (SMR); the effect of different therapies on survival was evaluated using Cox regression analysis.
  
  
  RESULTS
  Twenty patients (4.5%) died between 1999 and 2009. Age- and sex-adjusted SMR was 0.70 (95% CI 0.43-1.08). The Cox regression analysis revealed that, in the whole population, both general risk factors (age and physical status) and specific factors for acromegaly (macroadenoma, hypopituitarism and uncontrolled disease) were associated with death. The most compromised patients at diagnosis had a higher mortality rate (P=0.001), which also occurred in patients with controlled acromegaly. Death occurred in 2.4% (adenomectomy), 2.6% (adenomectomy followed by somatostatin analogue (SSA) therapy) and 11.4% (SSA therapy as the primary therapy) of the patients. The risk of death was higher in patients receiving SSA therapy as the primary therapy (hazard ratio (HR) 5.52, 95% CI 1.06-28.77, P=0.043) than in all patients submitted to adenomectomy; however, a higher risk of death occurred only in diabetic patients treated with SSAs alone (HR 21.94, 95% CI 1.56-309.04, P=0.022). Radiotherapy was associated with an increased risk of mortality, which occurred in patients with the more locally advanced disease.
  
  
  CONCLUSIONS
  Therapies for acromegaly and comorbidities have lowered the risk of mortality to the level of the general population; the effect of SSA therapy alone or that following pituitary adenomectomy was comparable to that of curative neurosurgery on survival in non-diabetic patients; on the contrary, SSA therapy as the primary therapy may be less effective than adenomectomy in reducing mortality rate in diabetic patients.
authors.affiliation: Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy. fausto.bogazzi@med.unipi.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Bogazzi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Martina
authors.initials: M
authors.lastname: Lombardi
authors.forename: Claudio
authors.initials: C
authors.lastname: Urbani
authors.forename: Chiara
authors.initials: C
authors.lastname: Sardella
authors.forename: Aldo
authors.initials: A
authors.lastname: Iannelli
authors.forename: Ilaria
authors.initials: I
authors.lastname: Scattina
authors.forename: Luca
authors.initials: L
authors.lastname: Manetti
authors.forename: Simone
authors.initials: S
authors.lastname: Del Sarto
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Ludovica Francesca Stella
authors.initials: LF
authors.lastname: Grasso
authors.forename: Isabella
authors.initials: I
authors.lastname: Lupi
authors.forename: Renata Simona
authors.initials: RS
authors.lastname: Auriemma
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Enio
authors.initials: E
authors.lastname: Martino
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects; D007558:Italy / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009026:Mortality; D010902:Pituitary Gland / Q000187:drug effects* / Q000601:surgery*; D012189:Retrospective Studies; D012727:Sex Characteristics; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D013004:Somatostatin