A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Acta Neuropathologica Année : 2013

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

Nathalie Sturm
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Emmanuelle Dantony
Christine Cortet-Rudelli
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Jean-François Bonneville
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Richard Assaker
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Aurélie Cornelius
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Henry Dufour
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Emmanuel Jouanneau
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Patrick François
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Gérald Raverot
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Anne A. Barlier
M. Bernier
F. Borson-Chazot
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O. Chabre
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P. Chanson
J. F. Cottier
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B. Delemer
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E. Delgrange
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L. Di Tommaso
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S. Eimer
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Sophie Gaillard
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M. Jan
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J. J. Girard
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V. Lapras
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H. Loiseau
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J. G. Passagia
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M. Patey
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A. Penfornis
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J. Y. Poirier
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G. Perrin
A. Tabarin
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Résumé

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.

Dates et versions

hal-00875723 , version 1 (22-10-2013)

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Jacqueline Trouillas, Pascal Roy, Nathalie Sturm, Emmanuelle Dantony, Christine Cortet-Rudelli, et al.. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up.. Acta Neuropathologica, 2013, 126 (1), pp.123-35. ⟨10.1007/s00401-013-1084-y⟩. ⟨hal-00875723⟩
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