title: PREDICTORS OF BIOCHEMICAL REMISSION AND RECURRENCE AFTER SURGICAL AND RADIATION TREATMENTS OF CUSHING DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
abstract: We conducted a systematic review and meta-analysis to synthesize the evidence about predictors that may affect biochemical remission and recurrence after transsphenoidal surgery (TSS), radiosurgery (RS), and radiotherapy (RT) in Cushing disease.
  
  
  
  We searched multiple databases through December 2014 including original controlled and uncontrolled studies that enrolled patients with Cushing disease who received TSS (first-line), RS, or RT. We extracted data independently, in duplicates. Outcomes of interest were biochemical remission and recurrence. A meta-analysis was conducted using the random-effects model to estimate event rates with 95% confidence intervals (CIs).
  
  
  
  First-line TSS was associated with high remission (76% [95% CI, 72 to 79%]) and low recurrence rates (10% [95% CI, 6 to 16%]). Remission after TSS was higher in patients with microadenomas or positive-adrenocorticotropic hormone tumor histology. RT was associated with a high remission rate (RS, 68% [95% CI, 61 to 77%]; RT, 66% [95% CI, 58 to 75%]) but also with a high recurrence rate (RS, 32% [95% CI, 16 to 60%]; RT, 26% [95% CI, 14 to 48%]). Remission after RS was higher at short-term follow-up (≤2 years) and with high-dose radiation, while recurrence was higher in women and with lower-dose radiation. Remission was after RT in adults who received TSS prior to RT, and with lower radiation doses. There was heterogeneity (nonstandardization) in the criteria and cutoff points used to define biochemical remission and recurrence.
  
  
  
  First-line TSS is associated with high remission and low recurrence, while RS and RT are associated with reasonable remission rates but important recurrence rates. The current evidence warrants low confidence due to the noncomparative nature of the studies, high heterogeneity, and imprecision.
authors.forename: Abd Moain Abu
authors.initials: AM
authors.lastname: Abu Dabrh
authors.forename: Naykky M
authors.initials: NM
authors.lastname: Singh Ospina
authors.forename: Alaa
authors.initials: A
authors.lastname: Al Nofal
authors.forename: Wigdan H
authors.initials: WH
authors.lastname: Farah
authors.forename: Patricia
authors.initials: P
authors.lastname: Barrionuevo
authors.forename: Maria
authors.initials: M
authors.lastname: Sarigianni
authors.forename: Arya B
authors.initials: AB
authors.lastname: Mohabbat
authors.forename: Khalid
authors.initials: K
authors.lastname: Benkhadra
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Carranza Leon
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gionfriddo
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Ahmed
authors.forename: Tarig A
authors.initials: TA
authors.lastname: Elraiyah
authors.forename: Qusay
authors.initials: Q
authors.lastname: Haydour
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000378:metabolism / Q000532:radiotherapy* / Q000601:surgery*; D000236:Adenoma / Q000175:diagnosis / Q000378:metabolism / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers