title: Prognostic Value of Invasion, Markers of Proliferation, and Classification of Giant Pituitary Tumors, in a Georeferred Cohort in Brazil of 50 Patients, with a Long-Term Postoperative Follow-Up.
abstract: Although some pituitary adenomas may have an aggressive behavior, the vast majority are benign. There are still controversies about predictive factors regarding the biological behavior of these particular tumors. This study evaluated potential markers of invasion and proliferation compared to current classification patterns and epidemiogeographical parameters. The study included 50 patients, operated on for tumors greater than 30 mm, with a mean postoperative follow-up of 15.2 ± 4.8 years. Pituitary magnetic resonance was used to evaluate regrowth, invasion, and extension to adjacent tissue. Three tissue biomarkers were analyzed: p53, Ki-67, and c-erbB2. Tumors were classified according to a combination of histological and radiological features, ranging from noninvasive and nonproliferative (grade 1A) to invasive-proliferative (grade 2B). Tumors grades 2A and 2B represented 42% and 52%, respectively. Ki-67 (p = 0.23) and c-erbB2 (p = 0.71) had no significant relation to tumor progression status. P53 (p = 0.003), parasellar invasion (p = 0.03), and classification, grade 2B (p = 0.01), were associated with worse clinical outcome. Parasellar invasion prevails as strong predictive factor of tumor recurrence. Severe suprasellar extension should be considered as invasion parameter and could impact prognosis. No environmental factors or geographical cluster were associated with tumor behavior.
authors.affiliation: Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.
authors.forename: Juliano Coelho de Oliveira
authors.identifier: 0000-0002-7468-4869
authors.initials: JC
authors.lastname: Zakir
authors.affiliation: Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.
authors.forename: Luiz Augusto
authors.identifier: 0000-0002-1315-4127
authors.initials: LA
authors.lastname: Casulari
authors.affiliation: Institute of Geosciences, University of Brasilia, Brasilia, Brazil.
authors.forename: José Wilson Corrêa
authors.identifier: 0000-0001-5464-407X
authors.initials: JW
authors.lastname: Rosa
authors.affiliation: Institute of Geosciences, University of Brasilia, Brasilia, Brazil.
authors.forename: João Willy Corrêa
authors.identifier: 0000-0001-9051-2285
authors.initials: JW
authors.lastname: Rosa
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.
authors.forename: Paulo Andrade
authors.identifier: 0000-0002-2641-6827
authors.initials: PA
authors.lastname: de Mello
authors.affiliation: Department of Pathology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.
authors.forename: Albino Verçosa
authors.initials: AV
authors.lastname: de Magalhães
authors.affiliation: Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.
authors.forename: Luciana Ansaneli
authors.identifier: 0000-0002-3363-3803
authors.initials: LA
authors.lastname: Naves