垂体后叶肿瘤的手术治疗及预后影响因素分析

Surgical treatment of posterior pituitary tumors and analysis of prognostic factors

目的探讨垂体后叶肿瘤(PPTs)的手术治疗及预后影响因素。方法回顾性分析2012年1月至2022年6月首都医科大学附属北京天坛医院神经外科行手术治疗的47例PPTs患者的临床资料。根据肿瘤的大小、部位以及是否侵袭海绵窦等分别采取不同的手术入路, 其中32例经蝶窦入路手术, 15例行开颅手术。采用Kaplan-Meier法分析患者的无进展生存期(PFS), 进一步采用单因素和多因素Cox回归分析法判断影响患者预后的临床因素。结果 47例PPTs患者中, 肿瘤全切除29例(61.7%), 次全切除18例(38.3%)。术中的中位出血量为200 ml(100~775 ml)。术后均明确病理学诊断, 其中垂体细胞瘤30例, 梭形细胞嗜酸细胞瘤6例, 颗粒细胞瘤6例, 混合型PPTs 5例。47例患者的中位随访时间为12个月(3~102个月), 至末次随访, 存活45例, 死亡2例, 肿瘤复发21例。Kaplan-Meier分析结果显示, 47例患者的总体中位PFS为10.0个月, 其中肿瘤全切除患者的中位PFS为12.0个月, 肿瘤未全切除患者的中位PFS为8.5个月, 不同肿瘤切除程度患者的中位PFS差异具有统计学意义(P<0.05)。多因素Cox回归分析显示, 术中出血量(HR=1.62, 95%CI:1.17~2.24)及肿瘤切除程度是PPTs患者PFS的独立影响因素, 其中肿瘤全切除(HR=0.34, 95%CI:0.12~0.94)是PPTs患者PFS的保护因素(均P<0.05)。结论术中出血量多、肿瘤未全切除的PPTs患者术后肿瘤易复发, 预后差。

Objective To investigate the surgical treatment and prognostic factors of posterior pituitary tumor(PPTs).MethodsThe clinical data of 47 patients with PPTs who underwent surgical treatment in the Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University from January 2012 to June 2022 were retrospectively analyzed.Different surgical approaches were adopted according to the tumor size,location,and whether it invaded the cavernous sinus.Among them,32 patients underwent transsphenoidal approach and 15 underwent craniotomy.The Kaplan-Meier method was used to analyze the progression-free survival(PFS)of the patients,and the univariate and multivariate Cox regression analyses were further used to determine the clinical factors affecting the prognosis of the patients.ResultsAmong the 47 patients with PPTs,29(61.7%)had total tumor resection and 18(38.3%)had subtotal tumor resection.The median intraoperative blood loss was 200 ml(100-775 ml).The pathological diagnosis was confirmed after operation,including 30 cases of pituitary cell tumor,6 cases of spindle cell oncocytoma,6 cases of granulosa cell tumor,and 5 cases of mixed posterior pituitary tumor.The median follow-up time of the 47 patients was 12 months(3-102 months),and at the last follow-up,45 patients survived,2 died,and 21 had tumor recurrence.The results of Kaplan-Meier analysis showed that the overall median PFS of 47 patients was 10.0 months.Among them,the median PFS of patients with total tumor resection was 12.0 months,and the median PFS of patients with incomplete tumor resection was 8.5 months.The difference in PFS between patients with various resection degrees was statistically significant(P<0.05).Multivariate Cox regression analysis showed that intraoperative blood loss(HR=1.62,95%CI:1.17-2.24)and the extent of tumor resection were independent factors affecting PFS.Among them,total tumor resection(HR=0.34,95%CI:0.12-0.94)was a protective factor for PFS(all P<0.05).ConclusionPatients with large intraoperative blood loss and incomplete tumor resection are prone to postoperative recurrence.