Expressions Of EphA2,MCM7,Ki-67 In Nonfunctioning Pituitary Adenomas And Their Predictive Value For Recurrence

Objective:To explore the expression levels of EphA2,MCM7 and Ki-67 in nonfunctioning pituitary adenomas,analyze their correlation with the recurrence of nonfunctioning pituitary adenomas after neuroendoscopic resection,and explore the predictive value of the three proteins for recurrence of tumor.Methods:A total of 60 patients with nonfunctioning pituitary adenomas who were admitted to the Department of Neurosurgery,Affiliated Hospital of Guizhou Medical University from October 2016 to October 2021 were collected and underwent neuroendoscopic transsphenoidal resection for complete resection.Hormone examination and postoperative pathological examination were confirmed as nonfunctioning pituitary adenoma.According to the recurrence or not,the tumor tissue samples were divided into two groups:recurrence group(n=16)and non-recurrence group(n=44).The age,gender,symptoms of the two groups of patients,preoperative serum anterior pituitary hormone levels and tumor volume and other clinical characteristics were analyzed and compared.Immunohistochemical methods were used to detect the expression of EphA2,MCM7 and Ki-67 in the two groups of specimens,and the semi-quantitative scoring method was used to quantify the immunohistochemical results.Statistical analysis was performed using SPSS 26.0statistical software.Results:1.Immunohistochemical results:Among the 16 cases of postoperative recurrent nonfunctioning pituitary adenomas:10 cases of EphA2 were strongly positive,3 cases were positive,1 case was weakly positive,and 2 cases were negative;5 cases were MCM7 had strong positive expression in 5 cases,positive expression in 4 cases,weak positive expression in 5 cases,and negative expression in 2 cases;Ki-67 had strong positive expression in 1 case,positive expression in 4 cases,weak positive expression in 8 cases,and negative expression in 3 cases.Among the 44 cases of non-recurrent nonfunctioning pituitary adenomas:2 cases with strong EphA2 expression,13 cases with positive expression,9 cases with weak positive expression,and 20 cases with negative expression;2 cases with strong positive expression of MCM7,7 cases with positive expression,and 20 cases with weak positive expression 7 cases,28 cases of negative expression;0 cases of strong positive expression of Ki-67,2 cases of positive expression,8 cases of weak positive expression,and 34 cases of negative expression.The expression levels of the three proteins in the recurrence group were significantly higher than those in the non-recurrence group,and the difference was statistically significant.The expression of the three proteins was not correlated with age and gender.2.The ROC curve analysis of single item predicting the recurrence of nonfunctioning pituitary adenomas by using EphA2,MCM7 and Ki-67immunohistochemical semi-quantitative scores,the corresponding areas under the curve(ROC-AUC)were 0.825,0.811 and 0.788,respectively.Statistical significance(P<0.05),the ROC-AUC area of EphA2 was the largest,and its sensitivity was the highest,followed by Ki-67 and MCM7.3.The average tumor volume in the recurrence group at the first visit was larger than that in the non-recurrence group,which were 5.5±0.83cm~3and 4.42±1.19cm~3respectively,and the difference between the groups was statistically significant(P=0.002).4.78.3%of patients with nonfunctioning pituitary adenomas had hypopituitarism before surgery,including 20 cases(33%)of thyroid hormone axis hypofunction,18cases(30%)with hypofunction of cortisol axis;gonadotropin axis hypofunction in 9cases(15%),no patient with hypofunction of growth hormone axis,and 13 cases(21%)without hypopituitarism in any axis.There was no significant difference between the recurrence group and the non-recurrent group with hypopituitarism(P=0.96).Conclusions:1.EphA2,MCM7,and Ki-67 are significantly highly expressed in patients with postoperative recurrence of nonfunctioning pituitary adenomas.EphA2,MCM7,and Ki-67 are involved in the recurrence process of nonfunctioning pituitary adenomas,and can be used to predict the recurrence of nonfunctioning pituitary adenomas as biological indicators of the likelihood of later recurrence.2.EphA2 is the most sensitive index for predicting postoperative recurrence of nonfunctioning pituitary adenomas,followed by Ki-67 and MCM7.