The Changing Treatment Paradigm for Prolactinoma-A Prospective Series of 100 Consecutive Neurosurgical Cases

Abstract

Purpose: To evaluate patients with prolactinoma treated surgically in a time when elective prolactinoma surgery became routine in our center, using a comprehensive outcome set, focusing on preoperative assessments, surgical outcomes, and health-related quality of life (HR-QoL).

Methods: Cohort of consecutive patients with prolactinoma undergoing surgery between January 2021 and August 2023. Clinical data were collected during multidisciplinary team meetings/from medical records at distinct timepoints: (1) presurgery, (2) 2 weeks postsurgery, (3) 6 months postsurgery, and (4) follow-up (median, 15.0 [10.0-24.8 months]). HR-QoL was measured using the Leiden Bothers and Needs Pituitary questionnaire. Data were described for all patients, and patients undergoing elective total resection, with additional subgroups of (1) patients undergoing a high-probability first total resection and (2) reoperations aiming for total resection.

Results: One hundred surgically treated patients with prolactinoma were included (72 female). Dopamine agonist intolerance was the most frequent indication (n = 68). The surgical goal (debulking/total resection) was achieved in 90% of patients. Long-term complications occurred in 4% of patients. Seventy-eight patients underwent an elective total resection, achieving remission in 91%. The subsets of preoperatively estimated high-probability-first total resections (n = 52) and reoperations (n = 9) achieved remission in 92% and 89%, respectively. Leiden Bothers and Needs Pituitary Total Bothers and Total Needs scores improved significantly after surgery (P < .001, Δ-3.4 [interquartile range, -14.4 to -0.9] and P = .006, Δ-1.8 [interquartile range, -11.9 to 1.3]), respectively.

Conclusion: High remission rates were achieved, improving HR-QoL, demonstrating (repeat) prolactinoma surgery is effective in an experienced pituitary center, as highlighted in the most recent guideline (2023).

Keywords: complications; health-related quality of life; prolactinoma; remission; transsphenoidal surgery.

Figure 1.

(A) Visualization of the subgroups in relation to the cohort, (B) evolution of the care pathway in time, and timepoints of data collection for the current study. The timepoints are described for the indicated (sub)groups in the main text and are available in the Supplementary Tables for the other (sub)groups. The current cohort partially overlaps with the PRolaCT study. Abbreviations: HR-QoL, Health-related quality of life; IHC, immunohistochemistry; IOQ, integrated outcome quadrants; MDT, multidisciplinary team. ^aIncluding 3 patients who underwent emergency surgery because of an apoplexy. ^bPatients with a lower probability of achieving total resection, yet undergoing a surgical attempt because of a high need for alternative treatment. These patients were not described separately.

Figure 2.

Pre- and postoperative health-related quality of life as measured by LBNQ-P, (A) for the entire cohort, n = 61 preoperative, n = 55 postoperative. Postoperative measurement median 175 (168-190) days postoperatively; (B) for patients undergoing an elective total resection, n = 50 preoperative, n = 45 postoperative. Postoperative measurement median 175 (168-192) days postoperatively; (C) for patients undergoing a high-probability first total resection, n = 35 preoperative, n = 33 postoperative. Postoperative measurement median 175 (168-189) days postoperatively; (D) for patients undergoing a reoperation for total resection, n = 5 preoperative, n = 4 postoperative. Postoperative measurement median 256 (170-341) days postoperatively. Abbreviations: iSeF, issues in sexual functioning; iSoF, issues in social functioning; LBNQ-P, Leiden Bothers and Needs Pituitary; Mood, mood problems; Nip, negative illness perceptions; PCC, physical and cognitive complaints.