The Effect And Prognostic Factors Of Neuroendoscopic Transsphenoidal Resection Of Invasive Pituitary Adenoma

ObjectiveTo explore the related factors affecting surgical resection and prognosis,improve the efficacy of surgical resection,reduce complications,and prolong the relapse-free survival time.MethodsData of 41 patients with invasive pituitary adenoma treated by endoscopically transsphenoidal approach in our hospital from January 2015 to June 2018 were retrospectively analyzed.Clinical data including gender,age,degree of tumor resection,invasion of cavernous sinus,internal carotid artery inclusion,pathological type,tumor texture,postoperative adjuvant therapy,ki-67 index,and duration of disease were collected,and univariate survival analysis was performed by kaplan-meier method.Finally,the variables with p value less than 0.05 in the univariate analysis were taken as the inclusion variables,and Cox multivariate regression analysis(inclusion criteria =0.05,exclusion criteria =0.1)was used for them.P<0.05 was considered as statistically significant,and independent predictors of recurrence were screened.ResultsA total of 41 cases were included in this study,including 20 males and 21 females,22 patients(81.5%)with improved visual field,11 patients(78.6%)with headache relief,and 9 patients(75%)with hormone relief.Postoperative diabetes insipidus occurred in 13 cases(31.7%),cerebrospinal fluid leakage in 2 cases(4.9%),intracranial infection in 1 case(2.6%),total tumor resection in 27 cases(65.9%),subtotal resection in 6 cases(14.6%),and partial resection in 8 cases(19.5%).There were 7 cases(17.1%)with recurrence,including 6 cases with incomplete resection and 1 case with total resection.The recurrence time was 3-42 months and the median recurrence survival time was 24 months.No serious complications such as internal carotid artery rupture and death occurred.Multivariate survival analysis was carried out for the variables of the location of the invasive cavernous sinus(P<0.016),the degree of encapturation of the internal carotid artery(P<0.014),the degree of resection(P<0.001)and postoperative adjuvant therapy(P<0.022),and multivariate Cox proportional risk regression analysis(inclusion criteria =0.05,exclusion criteria =0.1)was used.The results of multivariate analysis showed that the degree of resection(complete resection)was an independent risk factor affecting the prognosis of patients(P<0.05),HR was 11.12,that is,the risk of tumor recurrence in patients with partial resection/total resection was 11.12 times that of patients with total resection.Conclusion1.Neuroendoscopic transsphenoidal resection of invasive pituitary adenoma is safe,effective and feasible,but some tumors cannot be completely removed.Therefore,postoperative adjuvant therapy is needed to achieve better results.2.The prognosis of invasive pituitary adenoma is the result of a combination of many factors.Postoperative adjuvant therapy can reduce or delay tumor recurrence and prolong the survival time without recurrence.3.Postoperative adjuvant radiotherapy can slow down the recurrence of the tumor,but postoperative radiotherapy may lead to pituitary dysfunction,so patients should regularly review the pituitary function after surgery,and carefully master the indications of postoperative adjuvant radiotherapy.4.Invasion of cavernous sinus,wrapped carotid artery,degree of resection,and postoperative adjuvant therapy are prognostic factors of invasive pituitary adenoma,but degree of resection(complete resection)is an independent risk factor affecting the prognosis of patients.