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A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case–control study of 410 patients with 8 years post-operative follow-up

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Abstract

Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case–control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.

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Acknowledgments

We thank Emily Witty from Angloscribe for help with the translation into English, A. Reynaud for her excellent technical assistance, P. Gérardi for typing the manuscript, Dr David Forman and Dr Alexandre Vasiljevic for helpful criticisms. Co-authors of HYPOPRONOS are Barlier A., Bernier M., Bonnet F., Borson-Chazot F., Brassier G., Caulet-Maugendre S., Chabre O., Chanson P., Cottier JF., Delemer B., Delgrange E., Di Tommaso L., Eimer S., Gaillard S., Jan M., Girard JJ., Lapras V., Loiseau H., Passagia JG., Patey M., Penfornis A., Poirier JY., Perrin G., Tabarin A. This work was supported by grants from the Ministère de la Santé (Programme Hospitalier de Recherche Clinique National no 27-43, HYPOPRONOS) and research contracts with the Institut National de la Santé et de la Recherche Médicale and the Ligue Contre le Cancer Rhône-Alpes.

Conflict of interest

The authors have nothing to disclose.

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Authors and Affiliations

  1. Université Lyon 1, Université de Lyon, Lyon, France

    Jacqueline Trouillas, Pascal Roy, Emmanuelle Dantony, Carole Auger, Emmanuel Jouanneau, François Chapuis, Laurent Villeneuve & Gérald Raverot

  2. Hospices Civils de Lyon, Lyon, France

    Pascal Roy, Emmanuelle Dantony, Emmanuel Jouanneau, François Chapuis, Laurent Villeneuve & Gérald Raverot

  3. INSERM, UMR-S1028, Lyon Neuroscience Research Center, Oncoflam Team, Lyon, 69372, France

    Carole Auger, Emmanuel Jouanneau & Gérald Raverot

  4. Service de Biostatistique, Hospices Civils de Lyon, Lyon, France

    Pascal Roy & Emmanuelle Dantony

  5. CNRS; UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France

    Pascal Roy & Emmanuelle Dantony

  6. Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France

    Emmanuel Jouanneau

  7. Pôle Information Médicale, Unité de Recherche Clinique, Hospices Civils de Lyon, Lyon, France

    François Chapuis & Laurent Villeneuve

  8. Fédération d’Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France

    Gérald Raverot

  9. Département d’Anatomie et de Cytologie Pathologiques, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France

    Nathalie Sturm

  10. Université Lille Nord de France, Lille, France

    Christine Cortet-Rudelli, Richard Assaker, Aurélie Cornelius & Claude-Alain Maurage

  11. Centre Hospitalo-Universitaire de Lille, Lille, France

    Christine Cortet-Rudelli, Richard Assaker, Aurélie Cornelius & Claude-Alain Maurage

  12. Département d’Endocrinologie, Centre Hospitalo-Universitaire de Lille, Lille, France

    Christine Cortet-Rudelli

  13. Service de Neurochirurgie, Centre Hospitalo-Universitaire de Lille, Lille, France

    Richard Assaker

  14. INSERM U837, Lille, 59800, France

    Claude-Alain Maurage

  15. Laboratoire d’Anatomie Pathologique, Centre Hospitalo-Universitaire de Lille, Lille, France

    Claude-Alain Maurage

  16. Laboratoire d’Anatomie et Cytologie Pathologiques, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France

    Gabriel Viennet

  17. Service de Radiologie, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France

    Jean-François Bonneville

  18. Service d’Endocrinologie, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France

    François Mougel

  19. Aix-Marseille Université, Marseille, France

    Thierry Brue, Henry Dufour & Dominique Figarella-Branger

  20. Service d’Endocrinologie, Diabète et Maladies Métaboliques, Hôpital de la Timone, Assistance-Publique Hôpitaux de Marseille, Marseille, France

    Thierry Brue

  21. Unité Mixte de Recherche 7286, Faculté de Médecine de Marseille, Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille (CRN2M), Centre National de la Recherche Scientifique, Aix-Marseille Université, 13284, Marseille, France

    Thierry Brue

  22. Centre de Référence des Maladies Rares d’Origine Hypophysaire, Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital de la Timone, 13005, Marseille, France

    Thierry Brue

  23. Département de Neurochirurgie, Hôpital de la Timone, Assistance-Publique Hôpitaux de Marseille, Marseille, France

    Henry Dufour

  24. Service d’Anatomie Pathologique et de Neuropathologie, Hôpital de la Timone, Assistance-Publique Hôpitaux de Marseille, Marseille, France

    Dominique Figarella-Branger

  25. Service de Neurochirurgie, Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours, Tours, France

    Patrick François

  26. Université Rennes 1, Rennes, France

    Françoise Galland

  27. Service d’Endocrinologie Diabétologie, Hôpital Sud, Rennes, France

    Françoise Galland

  28. Centre de Pathologie Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Lyon, France

    Jacqueline Trouillas

  29. INSERM, UMR-S1028, Lyon Neuroscience Research Center, Oncoflam Team, Rue Guillaume Paradin, Lyon Cedex 08, 69372, France

    Jacqueline Trouillas

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  1. Jacqueline Trouillas
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  2. Pascal Roy
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  3. Nathalie Sturm
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  4. Emmanuelle Dantony
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  5. Christine Cortet-Rudelli
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  6. Gabriel Viennet
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  7. Jean-François Bonneville
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  8. Richard Assaker
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  9. Carole Auger
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  10. Thierry Brue
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  11. Aurélie Cornelius
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  12. Henry Dufour
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  13. Emmanuel Jouanneau
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  14. Patrick François
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  15. Françoise Galland
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  16. François Mougel
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  17. François Chapuis
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  18. Laurent Villeneuve
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  19. Claude-Alain Maurage
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  20. Dominique Figarella-Branger
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  21. Gérald Raverot
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Correspondence to Jacqueline Trouillas.

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Trouillas, J., Roy, P., Sturm, N. et al. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case–control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 126, 123–135 (2013). https://doi.org/10.1007/s00401-013-1084-y

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  • DOI: https://doi.org/10.1007/s00401-013-1084-y

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