Predictors of postoperative biochemical remission in acromegaly

doi:10.1007/s11060-020-03669-4

. 2021 Jan;151(2):313-324.

doi: 10.1007/s11060-020-03669-4. Epub 2021 Jan 4.

Predictors of postoperative biochemical remission in acromegaly

Shun Yao^#^{1

2}, Wen-Li Chen¹, Sherwin Tavakol^{2

3}, Farhana Akter⁴, Michael P Catalino^{2

5}, Xiaopeng Guo⁶, Jie Luo⁷, Ai-Liang Zeng⁸, Leo Zekelman⁹, Zhi-Gang Mao¹, Yong-Hong Zhu¹⁰, Qing-Zhi Wu¹¹, Edward R Laws Jr², Wenya Linda Bi¹², Hai-Jun Wang¹³

Affiliations

¹ Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China.
² Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
³ Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA.
⁵ Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA.
⁶ Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA, USA.
¹⁰ Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China.
¹¹ State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, Hubei, China.
¹² Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA. wbi@bwh.harvard.edu.
¹³ Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China. wanghaij@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 33394265
PMCID: PMC10077515
DOI: 10.1007/s11060-020-03669-4

Predictors of postoperative biochemical remission in acromegaly

Shun Yao et al. J Neurooncol. 2021 Jan.

. 2021 Jan;151(2):313-324.

doi: 10.1007/s11060-020-03669-4. Epub 2021 Jan 4.

Authors

Affiliations

¹ Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China.
² Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
³ Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁴ Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA.
⁵ Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA.
⁶ Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA, USA.
¹⁰ Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China.
¹¹ State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, Hubei, China.
¹² Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA. wbi@bwh.harvard.edu.
¹³ Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Rd, Yuexiu District, Guangzhou, 510080, Guangdong, China. wanghaij@mail.sysu.edu.cn.

^# Contributed equally.

PMID: 33394265
PMCID: PMC10077515
DOI: 10.1007/s11060-020-03669-4

Abstract

Purpose: Acromegaly is a rare neuroendocrine condition that can lead to significant morbidity. Despite China's vast population size, studies on acromegaly remain sparse. This study aimed to investigate the clinical characteristics and predictors of biochemical remission after surgery for acromegaly using the China Acromegaly Patient Association (CAPA) database.

Methods: A retrospective nationwide study was conducted using patient-reported data from CAPA database between 1998 and 2018. The principal component analysis (PCA) and logistic regression analysis were employed to determine independent predictors of biochemical remission at 3 months in patients after surgery.

Results: Of the 546 surgical cases (mean age: 36.8 years; 59.5% females), macroadenomas and invasive tumors (Knosp score 3-4) were 83.9% and 64.1%, respectively. Ninety-five percent of patients were treated with endonasal surgery and 36.8% exhibited biochemical remission at 3-months postoperatively. The following independent predictors of biochemical remission were identified: preoperative growth hormone (GH) levels between 12 and 28 μg/L [odds ratio (OR) = 0.58; 95% confidence interval (CI), 0.37-0.92; p = 0.021], preoperative GH levels > 28 μg/L (OR = 0.55; 95% CI, 0.34-0.88; p = 0.013), macroadenoma (OR = 0.56; 95% CI, 0.32-0.96; p = 0.034), giant adenomas (OR = 0.14; 95% CI, 0.05-0.38; p < 0.001), Knosp score 3-4 (OR = 0.37; 95% CI, 0.24-0.57; p < 0.001), and preoperative medication usage (OR = 2.32; 95% CI, 1.46-3.70; p < 0.001).

Conclusions: In this nationwide study spanning over two decades, we highlight that higher preoperative GH levels, large tumor size, and greater extent of tumor invasiveness are associated with a lower likelihood of biochemical remission at 3-months after surgery, while preoperative medical therapy increases the chance of remission.

Keywords: Acromegaly; Biochemical remission; Growth hormone; Pituitary tumor; Predictors.

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Conflict of interest statement

Conflict of interest The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

**Fig. 1**
a Distribution of cases by Knosp classification and tumor size. **b, c** The association of preoperative growth hormone (GH) levels compared with tumor size and Knosp score

**Fig. 2**
The cumulative rate of biochemical remission over the period of follow-up after surgery in acromegaly patients

See this image and copyright information in PMC

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References

1. Katznelson L, Laws ER, Melmed S et al. (2014) Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 99:3933–3951. 10.1210/jc.2014-2700 - DOI - PubMed
1. Colao A, Grasso LFS, Giustina A et al. (2019) Acromegaly. Nat Rev Dis Primers. 10.1038/s41572-019-0071-6 - DOI - PubMed
1. Cook DM, Ezzat S, Katznelson L et al. (2004) AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract 10:213–225. 10.4158/EP.10.3.213 - DOI - PubMed
1. Abreu A, Tovar AP, Castellanos R et al. (2016) Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 19:448–457. 10.1007/s11102-016-0725-2 - DOI - PMC - PubMed
1. Melmed S (2006) Acromegaly. N Engl J Med 355:2558–2573. 10.1056/NEJMra062453 - DOI - PubMed

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[1] Katznelson L, Laws ER, Melmed S et al. (2014) Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 99:3933–3951. 10.1210/jc.2014-2700 - DOI - PubMed

[2] Katznelson L, Laws ER, Melmed S et al. (2014) Acromegaly: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 99:3933–3951. 10.1210/jc.2014-2700 - DOI - PubMed

[3] Colao A, Grasso LFS, Giustina A et al. (2019) Acromegaly. Nat Rev Dis Primers. 10.1038/s41572-019-0071-6 - DOI - PubMed

[4] Colao A, Grasso LFS, Giustina A et al. (2019) Acromegaly. Nat Rev Dis Primers. 10.1038/s41572-019-0071-6 - DOI - PubMed

[5] Cook DM, Ezzat S, Katznelson L et al. (2004) AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract 10:213–225. 10.4158/EP.10.3.213 - DOI - PubMed

[6] Cook DM, Ezzat S, Katznelson L et al. (2004) AACE Medical Guidelines for Clinical Practice for the diagnosis and treatment of acromegaly. Endocr Pract 10:213–225. 10.4158/EP.10.3.213 - DOI - PubMed

[7] Abreu A, Tovar AP, Castellanos R et al. (2016) Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 19:448–457. 10.1007/s11102-016-0725-2 - DOI - PMC - PubMed

[8] Abreu A, Tovar AP, Castellanos R et al. (2016) Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary 19:448–457. 10.1007/s11102-016-0725-2 - DOI - PMC - PubMed

[9] Melmed S (2006) Acromegaly. N Engl J Med 355:2558–2573. 10.1056/NEJMra062453 - DOI - PubMed

[10] Melmed S (2006) Acromegaly. N Engl J Med 355:2558–2573. 10.1056/NEJMra062453 - DOI - PubMed

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Predictors of postoperative biochemical remission in acromegaly

Affiliations

Predictors of postoperative biochemical remission in acromegaly

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