垂体无功能腺瘤术后残留肿瘤自然生长史的研究

Natural history study of postoperative residual non-functioning pituitary adenomas

目的对垂体无功能腺瘤术后残留肿瘤采用单纯的观察随访，分析残留肿瘤的自然生长史，为临床选择恰当的治疗方案和治疗时机提供依据。方法20例垂体无功能腺瘤患者术后没有经过放疗和药物治疗情况下，观察其残留肿瘤的自然生长情况。通过随访的MRI图像系统测量肿瘤体积，计算肿瘤的月增长率，肿瘤倍增时间，并分析肿瘤倍增时间与年龄、性别、残余体积大小、海绵窦侵袭等因素的内在关系。结果20例患者接受单纯随访观察，平均随访时间为3．90年，术后第1次随访MRI时患者平均年龄为41．8岁。17例（85％）术后残留肿瘤体积出现不同程度增大，3例（15％）术后残留肿瘤体积无明显变化。17例复发的残留肿瘤体积大小平均为4．73cm^3，随访末次肿瘤体积平均为16．98cm^3，在平均随访的4．08年内肿瘤月平均增长率为7．87％，肿瘤倍增时间平均为724d。肿瘤倍增时间与年龄、性别、术后残留体积大小、海绵窦侵袭没有显著相关性。结论垂体无功能腺瘤术后残留肿瘤的自然生长速率与患者的性别、年龄及术后残余体积无显著相关性。根据残留肿瘤大小和肿瘤与周围结构的关系，结合肿瘤倍增时间以确定恰当的术后安全随访时间。

Objective To observe the postoperative residual non-functioning pituitary adenomas （PR-NFPAs） without postoperative radiotherapy and to analyze the natural history of PR-NFPAs＇ growth in order to provide a basis for selecting appropriate strategies of clinical treatment. Methods We evaluated the natural history of 20 patients with PR-NFPAs who did not receive postoperative radiotherapy and drug therapy. Through MRI images, the residual tumor volumes of those patients were serially measured. We further calculated the monthly growth rate and the tumor volume doubling time （TVDT） and analyzed the correlations between the patient age, gender, volmne of residual tumor, cavernous sinus （CS） invasion and TVDT. Results All patients received observation alone. Among which, 17 adenomas increased in volume and 3 remained unchanged during a follow-up period of 7 months to 17 years （mean 3.90 yr）. The mean patient age was 41.8 years. As to 17 patients with tumor regrowth, the tumor volume at the beginning of MRI observation period was 4. 73 cm^3 and tumor volume at the last MRI observation was 16. 98 cm^3. During the mean 4-year follow-up period, the average monthly growth rate of PR-NFPAs was 7.87% and the mean TVDT was 724 days. Such factors as patient age, gender, volume of residual tumor and CS invasion did not affect the TVDT of PR-NFPAs. Conclusion The tumor growth rate of PR-NFPAs is not significantly correlated with the patient gender, age, volume of residual tumor and CS invasion. In conjunctions with the volume of PR-NFPAs and the distance between residual adenoma and optic chiasm, we should take the TVDT into consideration and determine the appropriate and safe follow-up period.