Grading of pituitary adenomas (PitNets): clinical and prognostic implications in a monocentric series

Giuseppe Giuffrida; Rosalinda Casablanca; Marta Ragonese; Salvatore Giovinazzo; Cotta Oana Ruxandra; Rosaria Certo; Ylenia Alessi; Marianna Scordo; Cristina Pizzimenti; Giovanni Tuccari; Angileri Filippo Flavio; Francesco Ferrau; Salvatore Cannavo

doi:10.1530/endoabs.90.P700

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Endocrine Abstracts (2023) 90 P700 | DOI: 10.1530/endoabs.90.P700

ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)

Grading of pituitary adenomas (PitNets): clinical and prognostic implications in a monocentric series

Giuseppe Giuffrida ¹ , Rosalinda Casablanca ² , Marta Ragonese ³ , Salvatore Giovinazzo ³ , Oana Ruxandra Cotta ² , Rosaria Certo ² , Ylenia Alessi ³ , Marianna Scordo ² , Cristina Pizzimenti ⁴ , Giovanni Tuccari ⁵ , Filippo Flavio Angileri ⁴ , Francesco Ferraù ^2,3 & Salvatore Cannavò ^2,3

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¹Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy; ²Endocrine Unit, ‘G. Martino’ University Hospital, Messina; ³Department of Human Pathology of Adulthood and Childhood, University of Messina; ⁴Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina; ⁵Department of Human Pathology of Adulthood and Childhood, Section of Pathology, University of Messina

Rationale: Pituitary neuroendocrine tumors (PitNets) are aggressive in 20% of cases, with local invasion, relapse/scarce response to conventional treatment, in the absence of reliable predictive parameters. In 2018, Trouillas et al. proposed a 5-tier prognostic classification, not widely validated yet. In our study we evaluated the outcomes of a PitNets monocentric series in the context of this classification.

Materials & Methods: We retrospectively evaluated 88 patients (51 M, 50.5±14.7 yrs) with functioning (FPA) or non-functioning pituitary macroadenomas (NFPA), referred to the Endocrine Unit of Messina University Hospital, and operated by the same neurosurgeon in the period 2015-2020. Of each patient we recorded demographic, clinical, radiological, biochemical data and visual field, both at diagnosis/last follow-up (median 3±1.5 yrs), therapeutical history and pathological data. Once defined the PitNets grade according to Trouillas et al., we correlated it to clinico-pathological features at diagnosis, and to the outcomes (last follow-up).

Results: 38.6% of patients were in the 1a grade, 7.9% in the 1b, 48.9% and 4.5% among 2a and 2b, respectively. Of 10 giant PitNets, 70% were 2a. At diagnosis, panhypopituitarism and visual field alterations were higher among 2a. GH-omas were significantly prevalent among 1a tumors, NFPA among 2a. 1a and 2a grade PitNets had a better response to single surgery (P<0.01), while cyberknife stereotactic radiotherapy was needed in 2a and 2b tumors. Panhypopituitarism/visual field alterations were more frequent among 2a PitNets even after surgery. Ki-67 was positively associated to persistent disease in FPA, while radiological invasion was associated to remnant presence among NFPA.

Conclusions: Invasive and not-proliferating PitNets (2a) were more frequently associated to impaired pituitary function/visual field before and after surgery. Less proliferating tumors (1a and 2a) were more responsive to surgery. Ki-67 related to disease persistence in FPA, while adiuvant radiotherapy was more used among invasive tumors. Thus, among ±1 cm PitNets, tumor invasion influences clinico-biochemical outcomes, while Ki-67 influences surgical outcomes.