Prognostic Factors in Prolactin Pituitary Tumors: Clinical, Histological, and Molecular Data from a Series of 94 Patients with a Long Postoperative Follow-Up

Context and Objective: Predicting pituitary tumor behavior remains a challenge. This multiparameter investigation aimed to identify markers for recurrence and progression in prolactin tumors. Design: From a cohort of patients treated for prolactin tumors by surgery, we retrospectively studied clinic...

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Published in:The journal of clinical endocrinology and metabolism 2010-04, Vol.95 (4), p.1708-1716
Main Authors: Raverot, Gérald, Wierinckx, Anne, Dantony, Emmanuelle, Auger, Carole, Chapas, Guillaume, Villeneuve, Laurent, Brue, Thierry, Figarella-Branger, Dominique, Roy, Pascal, Jouanneau, Emmanuel, Jan, Michel, Lachuer, Joël, Trouillas, Jacqueline
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biochemistry
Biochemistry, Molecular Biology
Disease Progression
DNA, Complementary
DNA, Complementary - biosynthesis
DNA, Complementary - genetics
Female
Follow-Up Studies
Gene Expression
Humans
Life Sciences
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Invasiveness - pathology
Neoplasm Recurrence, Local
Neoplasm Recurrence, Local - epidemiology
Pituitary Hormones
Pituitary Hormones - genetics
Pituitary Neoplasms
Pituitary Neoplasms - genetics
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Prognosis
Prolactinoma
Prolactinoma - genetics
Prolactinoma - pathology
Prolactinoma - surgery
Reverse Transcriptase Polymerase Chain Reaction
RNA
RNA - biosynthesis
RNA - genetics
Young Adult
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Summary:Context and Objective: Predicting pituitary tumor behavior remains a challenge. This multiparameter investigation aimed to identify markers for recurrence and progression in prolactin tumors. Design: From a cohort of patients treated for prolactin tumors by surgery, we retrospectively studied clinical data, tumor characteristics, clinical outcome, and the expression of nine genes by quantitative RT-PCR. Results: This study included 94 patients (62 females and 32 men), with long postoperative follow-up periods (mean, 138 ± 46 months); 54.3% of patients had a macro or giant adenoma. Tumors were classified into three pathological groups based on their radiological and histological characteristics (noninvasive, 61; invasive, 22; and aggressive-invasive, 11). Immediately after surgery, 60 patients (63.8%) went into remission (prolactin level normalization). Persistently elevated prolactin levels (36.2%) were associated with increasing age, male sex, high preoperative prolactin levels, large tumor size on univariate analysis, and invasion and pathological classification on univariate and multivariate (P = 8 × 10−10 and 3 × 10−8) analysis. During follow-up, 19 patients (20%) had tumors that recurred or progressed under dopamine agonist treatment. Invasion and pathological classification were associated with recurrence or progression on univariate analysis. Seven genes (ADAMTS6, CRMP1, PTTG, ASK, CCNB1, AURKB, and CENPE) were associated with tumor recurrence or progression and five of these (ADAMTS6, CRMP1, ASK, CCNB1, and CENPE) were associated with the pathological classification. Conclusion: This study identifies both the clinical and histological factors that relate to prolactin tumor recurrence or progression. Molecular markers give additional information for prognosis of such tumors. Altogether, our results could influence the management of patients with pituitary tumors. A multiparameter investigation identifies age, male sex, preoperative prolactin levels, tumor size, invasion, pathological classification, and expression of a set of genes as prognostic markers for recurrence and progression in prolactin tumors.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2009-1191