Prognosis value of pituitary neuroendocrine tumor volume

Abstract

This study highlights the significance of considering pituitary neuroendocrine tumor volume when determining the appropriate line of therapy for patients with acromegaly. The findings suggest that, although tumor volume may assist in predicting the need for more aggressive treatment strategies, it is not a reliable indicator of disease persistence following surgical intervention. Further research is warranted to investigate additional factors influencing acromegaly treatment outcomes to enhance patient care.

Key Words: Pituitary neuroendocrine tumor; Surgery; Prognostic factor; Tumor volume; Predictive analysis

Core Tip: Pituitary neuroendocrine tumor volume serves as a complementary prognostic factor for disease control in patients with acromegaly. Larger tumors are associated with a higher risk of persistent disease and an increased likelihood of requiring medical treatment following surgery. The consideration of tumor volume is essential in clinical decision-making when managing acromegaly.

TO THE EDITOR

The study found no significant difference in the mean pituitary neuroendocrine tumor (PitNET) volume between patients with and without persistent disease following surgery (P = 0.09)[1]. However, when stratified by the line of therapy, patients receiving third- or fourth-line treatment had a significantly larger mean PitNET volume than those receiving first- or second-line therapy (6148 mm³ vs 2995 mm³, P < 0.001). These results suggest that PitNET volume is a valuable prognostic factor for determining the line of therapy required to manage acromegaly, although it does not predict disease persistence after surgical intervention.

The key findings of this study should be encouraged and suggested for further consideration as follows. A positive correlation was observed between PitNET volume and preoperative insulin-like growth factor 1 (IGF-1) levels, indicating that larger tumors are associated with higher IGF-1 concentrations. Tumor volume demonstrated a negative correlation with the probability of achieving disease control after surgery, suggesting that larger tumors are associated with a poorer postoperative prognosis. Furthermore, larger tumors are linked to an increased risk of requiring medical treatment following surgery, highlighting the importance of tumor size in determining the need for additional therapy. No significant correlation was identified between tumor volume and postoperative IGF-1 levels or the duration of disease control, implying that other factors may also contribute to disease progression. The study suggests that larger tumors may necessitate a more aggressive surgical approach or additional medical therapy to achieve adequate disease control[1]. Close monitoring of patients with larger tumors is essential, as they present a higher risk of persistent disease and may require more intensive follow-up.

The study highlights the importance of considering PitNET volume when determining the appropriate line of therapy for patients with acromegaly[1]. It also suggests that, although tumor volume can assist in predicting the need for more aggressive treatment, it may not serve as a reliable indicator of disease persistence following surgical intervention. Further research is warranted to explore additional factors influencing treatment outcomes in acromegaly and improving patient care. PitNET volume represents a complementary prognostic factor for disease control in patients with acromegaly. Larger tumors are associated with a higher risk of persistent disease and an increased need for medical treatment following surgery. These findings reinforce the importance of incorporating tumor volume into the clinical decision-making process for managing acromegaly.

Further studies are needed to explore the mechanisms underlying the association between tumor volume and disease outcomes, as well as to identify additional potential prognostic factors. The following recommendations are provided regarding postoperative surveillance. Postoperative monitoring is critical in ensuring patient recovery and timely detection of potential complications.

POSTOPERATIVE SURVEILLANCE

Regular follow-up

A personalized follow-up plan should be developed based on the type of surgical intervention and the patient’s condition. For PitNET, regular follow-up is typically recommended at 1 month, 3 months, 6 months, and 1 year after surgery. The frequency of follow-up should be adjusted according to the patient’s clinical status.

Monitoring biochemical indicators

Biochemical markers, including growth hormone (GH) and IGF-1, should be assessed regularly to evaluate disease control and treatment efficacy.

Imaging

Periodic magnetic resonance imaging or computed tomography scans are recommended to monitor for tumor recurrence or residual disease. Imaging studies can provide detailed information regarding tumor size and morphology, aiding in the detection of recurrence or residual disease.

Symptom assessment

Patients should be monitored for any new or recurrent symptoms, such as headaches, visual disturbances, and abnormal hormone levels, which may indicate tumor recurrence or progression.

Quality of life assessment

Regular evaluation of quality of life is essential, including assessments of physical, psychological, and social functioning, to understand the overall impact of surgery and subsequent treatment on the patient's well-being.

Drug side effect monitoring

Managing this disease often requires postoperative adjuvant pharmacological therapy. Several classes of drugs are routinely used in clinical practice. Dopamine agonists, such as cabergoline and bromocriptine, are commonly prescribed. Their side effects include nausea, dizziness, and orthostatic hypotension. Chronic use may lead to neuropsychiatric symptoms, including impulse control disorders and depression. Somatostatin analogs, such as octreotide and lanreotide, can cause gastrointestinal reactions (diarrhea, abdominal pain), cholelithiasis, and abnormalities in glucose metabolism, including hyperglycemia or hypoglycemia. GH receptor antagonists, such as pegvisomant, are often associated with abnormal liver function and headaches.

The following management strategies are recommended to address the side effects of these therapies: (1) Regular assessment of impulse control and mood status in patients receiving dopamine agonists; (2) Monitoring blood glucose levels and gallbladder ultrasound every 3 months during treatment with somatostatin analogs; (3) Weekly blood tests during treatment with pegvisomant, with the administration of granulocyte colony-stimulating factor if necessary; and (4) In addition, treatment regimens should be personalized and adjusted according to the degree of tumor differentiation and drug sensitivity.

Nutrition and metabolic assessment

Assess the nutritional status and metabolic changes to ensure that patients receive appropriate nutritional support, particularly when using GH replacement therapy.

CONCLUSION

Tumor volume plays an important role in predicting the need for more aggressive treatment strategies to pituitary neuroendocrine tumor, while it is not a reliable indicator of disease persistence following surgical intervention. Further research is warranted to investigate additional factors influencing acromegaly treatment outcomes to enhance patient care.