Endoscopic Endonasal Surgical Treatment Of Growth Hormone Adenomas Pituitary And Analysis Of Factors Associated With Postoperative Unbiochemical Cure

OBJECTIVE:Endoscopic endonasal surgery(EES)has become the first-line treatment option for pituitary growth hormone adenomas(GHPAs).However,there are still a relatively significant number of patients with unsatisfactory biochemical cure(BC)results after EES treatment.This article aims to investigate the surgical outcomes of EES for GHPAs and to analyze the factors associated with patients who are unbiochemically cured after EES treatment.METHODS:A retrospective analysis of the clinical and imaging data of 94 patients with GHPAs treated by EES from January 2017 to December 2021 in the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University was conducted in this study,firstly,the effect of EES treatment was analyzed,and then patients with no residual tumor on imaging were included in the analysis of relevant factors,and according to the Chinese Consensus on the Diagnosis and Treatment of Acromegaly2021 edition criteria,the patients were The patients were divided into biochemically cured and un-biochemically cured groups,and the influencing factors related to nonbiochemical cure after endoscopic transnasal surgery for GHPAs were investigated by analyzing and comparing the demographic information,clinical data,endocrine laboratory results,neuroradiology,intraoperative data and pathology between the two groups.RESULTS:Among 94 patients with GHPAs,7 patients had tumor residue on postoperative imaging review and were un-biochemically cured.87 patients had no tumor residue on postoperative imaging review and 47 patients were biochemically cured,while 40 patients were not biochemically cured.The analysis between the biochemically cured group and the non-biochemically cured group showed statistically significant differences in age,suprasellar tumor grade,Knosp grade,preoperative IGF-1 and OGTT-GH nadir values(all P<0.05).Incorporating multifactorial binary logistic regression analysis,the results showed that preoperative IGF-1 levels(OR=1.011,95%CI: 1.006～1.016,P=0.000<0.001),OGTT-GH nadir values(OR=1.064,95%CI:1.004～1.128,P=0.037<0.05),Knosp grade 4(OR=9.626,95% CI: 1.292～71.728,P=0.027),supratentorial tumor saddle grade 2(OR=9.933,95% CI: 1.157～85.301,P=0.036)was an independent factor influencing the patients’ postoperative failure to biochemically cure.CONCLUSION:In conclusion,under the individualized surgical strategy of EES in our center,EES is the preferred safe and effective method for the treatment of patients with GHPAs-type acromegaly,with the advantages of high total resection rate,low complication rate,and preservation of pituitary function,with high postoperative benefit to patients and maximizing the biochemical cure rate of patients.The results of the correlation factor analysis confirmed the greater difficulty of biochemical cure after endoscopic endonasal surgery for GHPAs when the tumor is of higher suprasellar invasion grade,higher preoperative IGF-1 and OGTT-GH nadir values,and higher Knosp grade.