经鼻蝶显微手术治疗功能性垂体腺瘤的复发危险因素分析

Analysis of risk factors for recurrence of functional pituitary adenoma by transsphenoidal microsurgery

目的分析经鼻蝶显微手术治疗功能性垂体腺瘤(FPAs)术后复发的危险因素,并构建判断FPAs术后复发的风险模型。方法回顾性分析2010年10月-2017年10月西安交通大学第一附属医院及西安交通大学第二附属医院共112例经鼻蝶显微手术切除FPAs患者的临床资料,应用医院门诊病历系统联合电话回访收集患者术后复诊情况,按患者随访结局分为复发组18例和未复发组94例。采用单因素分析和Cox回归分析判定FPAs患者术后复发的相关危险因素。结果两组患者性别、年龄、肿瘤病理分型及是否首次手术比较,差异无统计学意义(P>0.05);两组患者术后Knosp分级、肿瘤直径、术后肿瘤残留、Ki-67表达情况及辅助治疗比较,差异有统计学意义(P<0.05)。经Cox多元回归分析发现,肿瘤直径[=3.120(95%CI:1.248,7.798),P=0.015]、术后肿瘤残余[RR=3.246(95%CI:1.289,8.178),P=0.012]及Ki-67表达[RR=1.151(95%CI:0.826,4.871),P=0.034]是影响FPAs患者术后复发的独立危险因素。结论肿瘤直径较大、术后肿瘤残余及Ki-67≥3%是FPAs患者术后复发的高危因素。早期识别复发高风险患者,及早实施应对措施可改善患者预后。

Objective To analyze the risk factors of recurrence of functional pituitary adenomas(FPAs)after transsphenoidal microsurgery,and to establish a functional model for judging the risk of recurrence of FPAs.Methods Retrospective analysis of 112 cases of FPAs undergoing transsphenoidal microsurgery admitted to the First Affiliated Hospital of Xian Jiaotong University and the Second Affiliated Hospital of Xi’an Jiaotong University from October 2010 to October 2017,and hospital outpatient medical record system and telephone call back were used to collect postoperative follow-up.The outcomes of patients were divided into recurrent group(18 cases)and non-recurrence group(94 cases).Univariate analysis and Cox regression analysis were used to determine the risk factors associated with postoperative recurrence of FPAs.Results There was no significant difference in gender,age and whether the first operation between two groups(P>0.05).Non-recurrence group were significantly different with the postoperative recurrence group in the tumor type,Knosp classification,tumor diameter,postoperative residual tumor,Ki-67 expression and adjuvant treatment(P<0.05).After multivariate Cox regression analysis,tumor diameter[RR=3.120(95%CI:1.248,7.798),P=0.015],postoperative tumor residual[RR=3.246(95%CI:1.289,8.178),P=0.012],and Ki-67 expression[RR=1.151(95%CI:0.826,4.871),P=0.034]were found to be independent risk factors for postoperative recurrence of FPAs.Conclusions Large tumor diameter,postoperative tumor residual,and Ki-67≥3%are high risk factors for postoperative recurrence of FPAs.Early identification of patients with high-risk recurrence and early implementation of response measures can improve patient outcomes.