Objective. Dopamine agonists (DAs) are recommended as the first-line treatment for prolactinomas; however, tumour recurrence after drug withdrawal remains a clinical problem. Recent studies have reported high remission rates via surgery in microprolactinomas. The aim of this systematic review and meta-analysis was to compare the clinical result of DA treatment with surgery as initial therapy in patients with treatment-naive microprolactinoma. Methods. A comprehensive literature search for studies and reports regarding microprolactinoma patients treated with DAs and/or surgery published between January 1970 and November 2020 was conducted using four electronic databases (PubMed, Embase, Google Scholar, and the Cochrane Library). Clinical treatment outcome was evaluated by the biochemical remission of serum prolactin level to normal after treatment. The I² statistic was used to quantify heterogeneity. Pooled data were analysed according to a random effect model. Results. Eighteen studies with 661 patients were included for analysis. The DA treatment group achieved a higher remission rate at ≥12 months follow-up (96% vs. 86%; ). Surgery showed a higher remission rate than the DA treatment group after the treatment withdrawal (78% vs. 44%; ). Patients with preoperative prolactin level of ≤200 ng/mL had a higher remission rate than patients with preoperative prolactin level of >200 ng/mL (92% vs. 40%; ). Conclusion. Surgery showed a high remission rate in treatment-naive microprolactinoma patients after treatment withdrawal and may be an alternative first-line treatment strategy in addition to DAs, particularly in patients with a preoperative prolactin level of ≤200 ng/mL.

中文翻译：

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微泌乳素瘤的手术和药物治疗：系统评价和荟萃分析

客观。推荐多巴胺激动剂（DAs）作为泌乳素瘤的一线治疗；然而，停药后的肿瘤复发仍然是一个临床问题。最近的研究报告了通过手术治疗微泌乳素瘤的高缓解率。本系统评价和荟萃分析的目的是比较 DA 治疗与作为初始治疗对初治泌乳素小瘤患者的临床手术结果。方法. 使用四个电子数据库（PubMed、Embase、Google Scholar 和 Cochrane Library）对 1970 年 1 月至 2020 年 11 月期间发表的关于接受 DAs 和/或手术治疗的微泌乳素瘤患者的研究和报告进行了全面的文献检索。通过治疗后血清催乳素水平的生化缓解至正常来评估临床治疗结果。I ²统计量用于量化异质性。根据随机效应模型分析汇总数据。结果。纳入 18 项研究，共 661 名患者进行分析。DA 治疗组在≥12 个月的随访中达到了更高的缓解率（96% 对 86%；）。停药后，手术的缓解率高于 DA 治疗组（78% vs. 44%；）。术前催乳素水平≤200 ng/mL 的患者的缓解率高于术前催乳素水平>200 ng/mL 的患者（92% vs. 40%；）。 结论。手术在停药后的初治微泌乳素瘤患者中显示出较高的缓解率，并且可能是除 DAs 之外的替代一线治疗策略，特别是对于术前催乳素水平≤200 ng/mL 的患者。