A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up.

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Trouillas, Jacqueline | Roy, Pascal | Sturm, Nathalie | Dantony, Emmanuelle | Cortet-Rudelli, Christine | Viennet, Gabriel | Bonneville, Jean-François | Assaker, Richard | Auger, Carole | Brue, Thierry | Cornelius, Aurélie | Dufour, Henry | Jouanneau, Emmanuel | François, Patrick | Galland, Françoise | Mougel, François | Chapuis, François | Villeneuve, Laurent | Maurage, Claude-Alain | Figarella-Branger, Dominique | Raverot, Gérald | Barlier, Anne, A. | Bernier, M. | Bonnet, Fabrice | Borson-Chazot, F. | Brassier, Gilles | Caulet-Maugendre, S. | Chabre, O. | Chanson, P. | Cottier, J. F. | Delemer, B. | Delgrange, E. | Di Tommaso, L. | Eimer, S. | Gaillard, Sophie | Jan, M. | Girard, J. J. | Lapras, V. | Loiseau, H. | Passagia, J. G. | Patey, M. | Penfornis, A. | Poirier, J. Y. | Perrin, G. | Tabarin, A.

Edité par CCSD ; Springer Verlag -

International audience. Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.

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