Prognostic Factors for Recurrence in Pituitary Adenomas: Recent Progress and Future Directions

Abstract

Pituitary adenomas (PAs) are benign lesions; nonetheless, some PAs exhibit aggressive behaviors, which lead to recurrence. The impact of pituitary dysfunction, invasion-related risks, and other complications considerably affect the quality of life of patients with recurrent PAs. Reliable prognostic factors are needed for recurrent PAs but require confirmation. This review summarizes research progress on two aspects-namely, the clinical and biological factors (biomarkers) for recurrent PAs. Postoperative residue, age, immunohistological subtypes, invasion, tumor size, hormone levels, and postoperative radiotherapy can predict the risk of recurrence in patients with PAs. Additionally, biomarkers such as Ki-67, p53, cadherin, pituitary tumor transforming gene, matrix metalloproteinase-9, epidermal growth factor receptor, fascin actin-bundling protein 1, cyclooxygenase-2, and some miRNAs and lncRNAs may be utilized as valuable tools for predicting PA recurrence. As no single marker can independently predict PA recurrence, we introduce an array of comprehensive models and grading methods, including multiple prognostic factors, to predict the prognosis of PAs, which have shown good effectiveness and would be beneficial for predicting PA recurrence.

Keywords: biomarkers; clinical factors; model; pituitary adenoma; prognostic factors; recurrence.

Figure 1

Summary of clinical prognostic factors for PA recurrence. Postoperative residue, invasion, aggressive subtypes, and higher preoperative serum hormone levels could promote the recurrence of PAs. Whereas postoperative radiotherapy, older age, smaller tumor size, and lower postoperative serum hormone levels could inhibit the recurrence of PAs.

Figure 2

Summary of biological factors (biomarkers) for PA recurrence. Prognostic biomarkers (highlighted in red) from various sources could be used as valuable tools for predicting the recurrence of PAs (see text for details). Pituitary tumor transforming gene (PTTG), matrix metalloproteinase (MMP), cyclooxygenase-2 (COX-2), epidermal growth factor receptor (EGFR), fascin actin-bundling protein 1 (FSCN1), epithelial mesenchymal transformation (EMT), extracellular signal-regulated kinase (ERK), mitogen-activated protein kinase (MAPK).