解放军医学杂志2025，Vol.50Issue(4)：393-399,7.DOI:10.11855/j.issn.0577-7402.1614.2025.0103
高分级无功能垂体神经内分泌肿瘤全切术后复发的相关风险因素分析
Analysis of recurrent risk factors associated with high-grade non-functional pituitary neuroendocrine tumors
摘要
Abstract
Objective To investigate the risk factors associated with recurrence of high-grade non-functioning pituitary neuroendocrine tumors(NF-PitNETs)following total resection.Methods A retrospective study was conducted on the clinical data of 252 patients with high-grade NF-PitNETs who underwent surgical treatment at the Department of Neurosurgery,Beijing Tiantan Hospital from January 2012 to December 2023,and met the inclusion criteria.High-grade NF-PitNETs included Knosp 3A,3B,and 4-grade subtypes.Kaplan-Meier curves and Log-rank tests were employed to compare the progression-free survival(PFS)of Knosp 3A,3B,and 4-grade patients.Cox regression analysis was applied to identify the risk factors associated with the recurrence of high-grade NF-PitNETs.Receiver operating characteristic(ROC)curve was used to calculate the area under the curve(AUC)of each recurrence-related factor to evaluate the diagnostic efficiency.Results Survival analysis revealed that there were significant differences in PFS among Knosp 3A,3B,and 4-grade patients(P<0.001).The PFS of Knosp 3A was significantly better than that of grade 3B and 4-grade(P<0.05),while there was no significant difference between Knosp 3B and 4-grade(P=0.118).After integrating the three groups into Knosp 3A group and 3B-4 group,there were significant differences in PFS and some clinical features between the two groups(P<0.05).Cox regression analysis indicated that age<55 years old(HR=2.883,95%CI 1.253-6.634;P=0.013),T2 heterogeneous signal(HR=1.842,95%CI 1.061-3.197;P=0.030),Knosp 3B-4(HR=2.190,95%CI 1.069-4.488;P=0.032),and Ki-67≥3%(HR=2.266,95%CI 1.265-4.061;P=0.006)were risk factors related to tumor recurrence.ROC curve analysis showed that the AUCs of the above-mentioned risk factors were 0.682,0.706,0.709 and 0.750,respectively,and the AUC of the multi-factor combined model(age+T2 signal+Knosp grade+Ki-67)was 0.838,which was significantly larger than that of each single risk factor(P<0.05).Conclusion High-grade NF-PitNETs patients with age<55 years old,T2 heterogeneous signal,Knosp 3B-4 and Ki-67≥3%have a higher recurrence risk.The combined application of multiple risk factors can improve the predictive value of recurrence.关键词
高分级/无功能垂体神经内分泌肿瘤/复发/风险因素Key words
high grade/non-functioning pituitary neuroendocrine tumors/recurrence/risk factors分类
临床医学引用本文复制引用
张哲,别志旭,刘丕楠,李朋..高分级无功能垂体神经内分泌肿瘤全切术后复发的相关风险因素分析[J].解放军医学杂志,2025,50(4):393-399,7.基金项目
This work was supported by the National Natural Science Foundation of China(81974387),and the Capital Clinical Characteristic Diagnosis and Treatment Technology Research and Transformation Application(Z221100007422041) 国家自然科学基金(81974387) （81974387）
首都临床特色诊疗技术研究及转化应用(Z221100007422041) （Z221100007422041）
