Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review

Abstract

Purpose: Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis.

Methods: We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression.

Results: In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008-8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015-12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240-15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335-17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020-9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486-309.595; p = 0.001).

Conclusion: Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.

Keywords: Diagnosis; Oncology; Pituicytoma; Radiotherapy; Total resection; Treatment strategy.

Fig. 1

The PRISMA flowchart shows the inclusion and exclusion processes used for analysis

Fig. 2

Brain magnetic resonance imaging showing flow void within the tumor. The mass mainly shows isointensity on axial T1WI (a) and T2WI (b); Postcontrast axial (c) and saggital (d) T1WI show a suprasellar lesion with a well-defined margins and obvious homogeneous enhancement. Note that within the mass there is a flow void (arrows in a–d) demonstrating the strong arterial supply of a highly vascularized tumor

Fig. 3

Histopathological examination revealed the typical morphological and immunohistochemical features of pituicytoma. a and b HE staining showed that the tumor cells were spindle shaped, with unclear boundary, abundant cytoplasm, fine nuclear chromatin and dense interweaving, arranged in fascicles and storiform. c–e The tumor displayed diffuse immunoreactivity for TTF-1, S-100 protein and vimentin. f–h The tumor exhibited focal positive staining for GFAP and EMA, with a low Ki67 index. HE hematoxylin–eosin; TTF‐1 thyroid transcription factor‐1; GFAP glial fibrillary acidic protein; EMA epithelial membrane antigen

Fig. 4

Statistically significant factors for time to progression. a TTP in the pooled cohort; b male and female groups; c TS and OT groups; d GTR and non-GTR groups. TTP time to progression; OT open transcranial; TS transsphenoidal surgery; GTR gross-total resection; EMTTP estimated mean time to progression

Fig. 5

Surgical management data for pituicytomas in the combined cohort. a data for patients undergoing initial surgery; b Classification of treatment after tumor progression. GTR gross-total resection; RT radiotherapy; NA not available