Efficacy and predictors of short-term first-generation somatostatin analog presurgical treatment in acromegaly: A hospital-based study of 237 cases,Growth Hormone and IGF Research

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Efficacy and predictors of short-term first-generation somatostatin analog presurgical treatment in acromegaly: A hospital-based study of 237 cases
Growth Hormone and IGF Research ( IF 1.4 ) Pub Date : 2020-09-24 , DOI: 10.1016/j.ghir.2020.101354
Ming Shen ₁ , Yeping Yang ₂ , Wenqiang He ₁ , Nidan Qiao ₁ , Min He ₃ , Xuefei Shou ₁ , Meng Wang ₂ , Zengyi Ma ₁ , Zhao Ye ₁ , Yichao Zhang ₁ , Zhengyuan Chen ₁ , Qilin Zhang ₁ , Xiang Zhou ₁ , Xiaoyun Cao ₁ , Hongying Ye ₃ , Yongfei Wang ₁ , Shiqi Li ₁ , Yiming Li ₃ , Yao Zhao ₄ , Zhaoyun Zhang ₅

Affiliation

Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key laboratory of Brain Function and Restoration and Neural Regenaration, Shanghai 200040, China.
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China; Neurosurgical Institute of Fudan University, Shanghai 200040, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China; Shanghai Key laboratory of Brain Function and Restoration and Neural Regenaration, Shanghai 200040, China.
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China; Shanghai Pituitary Tumor Center, Shanghai 200040, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.

Objective

To investigate the effectiveness and predictors of short-term somatostatin analog (SSA) presurgical therapy in a large cohort and to assess the correlation between clinical and pathological variables.

Design

237 newly diagnosed patients with acromegaly received presurgical SSA treatment for three months were recruited. Clinical characteristics were collected, and response to SSA in hormone and tumor size was evaluated. The correlation between clinical information and pathological variables were analyzed.

Results

After 3 months presurgical SSA therapy, 51 (21.5%) patients were biochemically responsive with ≥50% decrease in IGF-1 while 126 (53.2%) patients showed at least 20% tumor size decrease. Biochemical responders were associated with a smaller maximum tumor diameter (MTD) and an older age (OR, 0.448; P = 0.003; OR, 1.050; P = 0.001). Tumor size responders were associated with a smaller MTD (OR, 0.435; P < 0.001). A combination of MTD < 2 cm and age ≥49 years predicted biochemical responders (PPV, 54.5%; NPV, 86.0%; P < 0.001), while MTD ≤2.2 cm (PPV, 67.1%; NPV, 67.0%; P < 0.001) predicted tumor size responders. Compared to patients with MTD < 2 cm, patients with MTD ≥ 2 cm showed higher percentage of sparsely granulated (SG) adenoma (62.1% vs. 31.3%, P = 0.005). In addition, the percentage of SG adenoma tended to be higher in patients < 49 years than ≥49 years (48.1% and 31.0% P = 0.089).

Conclusions

The baseline MTD and age correlate with granulation patterns and may be used as easily acquired predictors of presurgical SSA treatment in acromegaly. Patients over their 50s with a tumor less than 2 cm in diameter are more likely to have a response to the short-term presurgical SSA therapy.

中文翻译：

短期第一代生长抑素类似物术前治疗肢端肥大症的疗效和预测因素：基于医院的 237 例研究

客观的

研究短期生长抑素类似物 (SSA) 术前治疗在大型队列中的有效性和预测因素，并评估临床和病理变量之间的相关性。

设计

招募了 237 名接受术前 SSA 治疗三个月的新诊断的肢端肥大症患者。收集临床特征，并评估激素和肿瘤大小对 SSA 的反应。分析临床信息与病理变量之间的相关性。

结果

经过 3 个月的术前 SSA 治疗后，51 名 (21.5%) 患者对 IGF-1 降低≥50% 产生生化反应，而 126 名 (53.2%) 患者显示肿瘤大小至少减少 20%。生化反应者与较小的最大肿瘤直径 (MTD) 和较高的年龄相关（OR，0.448；P = 0.003；OR，1.050；P = 0.001）。肿瘤大小应答者与较小的 MTD 相关（OR，0.435；P < 0.001）。MTD < 2 cm 和年龄≥49 岁的组合预测生化反应者（PPV，54.5%；NPV，86.0%；P < 0.001），而 MTD ≤2.2 cm（PPV，67.1%；NPV，67.0%；P < 0.001) 预测的肿瘤大小反应者。与 MTD < 2 cm 的患者相比，MTD ≥ 2 cm 的患者显示出更高比例的稀疏颗粒 (SG) 腺瘤（62.1% 对 31.3%，P = 0.005）。此外，<49 岁患者的 SG 腺瘤百分比往往高于 49 岁以上患者（48.1% 和 31.0% P = 0.089）。