ECE2016 Eposter Presentations Pituitary - Clinical (83 abstracts)
Predictive factors of surgical outcomes in acromegaly: what’s new in 2016?
Marion Lapoirie 1 , Alexandre Vasiljevic 2 , Muriel Rabilloud 3 , Véronique Lapras 4 , Laura Chinezu 5 , Jacqueline Trouillas 2 , Emmanuel Jouanneau 6 & Gérald Raverot 1
1Fédération d’Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France; 2Centre de Pathologie et Neuropathologie Est, CHU de Lyon-GH Est, Bron, France; 3Service de biostatistique, Hospices Civils de Lyon, Lyon, France; 4Service de radiologie, CHU de Lyon-GH Est, Bron, France; 5Department of Histology, University of Medicine and Pharmacy, Tirgu Mures, Romania; 6Service de neurochirurgie, groupement hospitalier Est, Hospices Civils de Lyon, Bron, France.
Introduction: In the era of personalized patient management in acromegaly, transsphenoidal surgery remains a treatment of choice in cases where surgical cure can be expected. In order to better target these patients and to assess the risk of persistence/progression disease, we evaluated clinical, hormonal, radiological and pathological predictors of surgical outcome in acromegaly.
Methods: A single-institution retrospective study from 2009 to 2015 was performed. From a cohort of 79 acromegalic patients operated by a single operator, 63 patients with complete pre- and postoperative work-up, magnetic resonance imaging (MRI) blinded evaluation and pathological analysis, with prognostic clinicopathological classification (J Trouillas et al.) were studied.
Results: Three month after surgery, remission rate defined by IGF-1 normalization and/or nadir GH/oral glucose tolerance test < 1.2 mUI/l, was 50.8%. In univariate analysis, no biological parameter was predictive of poor outcomes. MRI-results: tumour diameter greater than 20 mm (P<0.05) and intracavernous extension (Knops ≥ 3) (P<0.05) were associated with a higher probability of not being cured. T2-weighted MRI signal was not associated with post-operative remission. Peroperative evaluation of infrasellar (P<0.05) and intracavernous invasion (P<0.01) were associated with a lower probability of cure. For pathological assessment, grade 2a and 2b tumors were predictive of non-healing (P<0.01). In multivariate analysis, 2a and 2b tumors, infrasellar and intracavernous invasion remained the major predictors of poor surgical outcome.
Conclusion: This study confirms that intracavernous invasion and tumour size seems to be the strongest parameters to predict surgical outcomes. Moreover, prognostic clinicopathological classification help to predict post-operative remission.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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