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

• Published in: Acta neuropathologica 2013-07, Vol.126 (1), p.123-135
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: ACTH; Adolescent; Adult; Age Factors; Aged; Case-Control Studies; Cell cycle; Development and progression; Diagnosis; Disease-Free Survival; Female; Human health and pathology; Humans; Hépatology and Gastroenterology; Life Sciences; Longitudinal Studies; Magnetic Resonance Imaging; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Neurosciences; Original Paper; Pathology; Pituitary Gland - pathology; Pituitary Gland - ultrastructure; Pituitary Neoplasms - classification; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Prognosis; Radiation therapy; Recurrence; Retrospective Studies; Sensitivity and Specificity; Sex Factors; Surgery; Tumor proteins; Tumors; Young Adult
• ISSN: 0001-6322; 1432-0533
• DOI: 10.1007/s00401-013-1084-y

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