Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis

Khi Yung Fong; Mervyn Jun Rui Lim; Shuning Fu; Chen Ee Low; Yiong Huak Chan; Doddabele Srinivasa Deepak; Xinni Xu; Mark Thong; Swati Jain; Kejia Teo; Paul A Gardner; Carl H Snyderman; Vincent Diong Weng Nga; Tseng Tsai Yeo

doi:10.1007/s11102-023-01335-2

Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis

Pituitary. 2023 Aug;26(4):461-473. doi: 10.1007/s11102-023-01335-2. Epub 2023 Jun 30.

Authors

Khi Yung Fong^#¹, Mervyn Jun Rui Lim^#^{2

3}, Shuning Fu¹, Chen Ee Low¹, Yiong Huak Chan⁴, Doddabele Srinivasa Deepak⁵, Xinni Xu⁶, Mark Thong⁶, Swati Jain⁷, Kejia Teo⁷, Paul A Gardner⁸, Carl H Snyderman⁹, Vincent Diong Weng Nga⁷, Tseng Tsai Yeo⁷

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore. mervynlim@u.nus.edu.
³ Division of Neurosurgery, University Surgical Centre, National University Hospital, Level 8, National University Health Systems Tower Block, 1E Kent Ridge Rd, Singapore, 119228, Singapore. mervynlim@u.nus.edu.
⁴ Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵ Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.
⁶ Division of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
⁷ Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
⁸ Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁹ Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

^# Contributed equally.

PMID: 37389776
DOI: 10.1007/s11102-023-01335-2

Abstract

Background: Surgical resection is the main treatment for symptomatic nonfunctioning pituitary adenomas (NFPA). We aimed to analyze the impact of surgical approach, completeness of resection, and postoperative radiotherapy on long-term progression-free survival (PFS) of NFPA, using individual patient data (IPD) meta-analysis.

Methods: An electronic literature searched was conducted on PubMed, EMBASE, and Web of Science from database inception to 6 November 2022. Studies describing the natural history of surgically resected NFPA, with provision of Kaplan-Meier curves, were included. These were digitized to obtain IPD, which was pooled in one-stage and two-stage meta-analysis to determine hazard ratios (HRs) and 95%CIs of gross total resection (GTR) versus subtotal resection (STR), and postoperative radiotherapy versus none. An indirect analysis of single-arm data between endoscopic endonasal (EES) and microscopic transsphenoidal (MTS) surgical technique was also performed.

Results: Altogether, eleven studies (3941 patients) were retrieved. PFS was significantly lower in STR than GTR (shared-frailty HR 0.32, 95%CI 0.27-0.39, p < 0.001). Postoperative radiotherapy significantly improved PFS compared to no radiotherapy (shared-frailty HR 0.20, 95%CI 0.15-0.26, p < 0.001), including in the subgroup of patients with STR (shared-frailty HR 0.12, 95%CI 0.08-0.18, p < 0.001). Similar PFS was observed between EES and MTS (indirect HR 1.09, 95%CI 0.92-1.30, p = 0.301).

Conclusions: This systematic review and patient-level meta-analysis provides a robust prognostication of surgically treated NFPA. We reinforce current guidelines stating that GTR should be the standard of surgical resection. Postoperative radiotherapy is of considerable benefit, especially for patients with STR. Surgical approach does not significantly affect long-term prognosis.

Registration: PROSPERO CRD42022374034.

Keywords: Meta-analysis; Neurosurgery; Pituitary adenoma; Pituitary neoplasms; Radiotherapy.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Endoscopy
Frailty*
Humans
Pituitary Neoplasms* / radiotherapy
Pituitary Neoplasms* / surgery
Prognosis
Progression-Free Survival
Retrospective Studies
Treatment Outcome