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Purpose <p>To identify clinical, radiographic, and biochemical predictors of acute surgical remission (ASR), long-term remission (LTR), and recurrence in patients undergoing endoscopic transsphenoidal surgery (ETSS) for prolactinoma.</p> Methods <p>A retrospective cohort study was conducted on 52 patients who underwent ETSS for histologically confirmed prolactinoma at a single center between 2010 and 2022.</p> Results <p>Remission was more likely in patients with microadenomas (ASR 72.2% vs. 41.2% macroadenomas, <i>p =</i> 0.03; LTR 44.4% vs. 17.6%, <i>p =</i> 0.052), Knosp 0–1 tumors (ASR 66.7% vs. 18.8% Knosp 2–4, <i>p =</i> 0.001; LTR 38.9% vs. 0%, <i>p =</i> 0.004), absence of cavernous sinus invasion (ASR 62.2% vs. 26.7%, <i>p =</i> 0.02; LTR 37.8% vs. 0%, <i>p =</i> 0.005), completely resected tumors (ASR 75.0% vs. 25.0%, <i>p</i> &lt; 0.001; LTR 50.0% vs. 0%, <i>p</i> &lt; 0.001). Patients achieving LTR had lower postoperative prolactin (4.5 vs. 28.0 ng/mL, <i>p =</i> 0.01). Median follow-up duration was 5.6 years, and median time to recurrence was 2.6 years. Recurrence was associated with higher peak prolactin (HR 1.003 per ng/mL, 95% CI: 1.001–1.01, <i>p</i> = 0.01), Knosp 2–4 tumors (HR 5.64, 95% CI: 1.40–22.80, <i>p</i> = 0.02), cavernous sinus invasion (HR 3.97, 95% CI: 1.15–13.64, <i>p</i> = 0.03), subtotal resection (HR 0.19 for GTR, 95% CI: 0.06–0.60, <i>p</i> = 0.01), and higher postoperative prolactin (HR 1.13 per ng/mL, 95% CI: 1.04–1.23, <i>p</i> = 0.01).</p> Conclusion <p>Tumor size, invasiveness, extent of resection, and prolactin levels are key predictors of remission and recurrence. These findings underscore risk-stratified decision-making and long-term surveillance.</p>

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Determinants of remission and recurrence following transsphenoidal surgery for prolactinoma: a single-center experience

  • 期刊论文

  • 发表日期：

    2026年5月23日

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  • William M. Burns,
  • Gurkirat Kohli,
  • Lu Wang,
  • George Kassis,
  • Nicholas Contento,
  • Prasanth Romiyo,
  • Samia Lopa,
  • Ismat Shafiq,
  • G. Edward Vates

摘要

Purpose

To identify clinical, radiographic, and biochemical predictors of acute surgical remission (ASR), long-term remission (LTR), and recurrence in patients undergoing endoscopic transsphenoidal surgery (ETSS) for prolactinoma.

Methods

A retrospective cohort study was conducted on 52 patients who underwent ETSS for histologically confirmed prolactinoma at a single center between 2010 and 2022.

Results

Remission was more likely in patients with microadenomas (ASR 72.2% vs. 41.2% macroadenomas, p = 0.03; LTR 44.4% vs. 17.6%, p = 0.052), Knosp 0–1 tumors (ASR 66.7% vs. 18.8% Knosp 2–4, p = 0.001; LTR 38.9% vs. 0%, p = 0.004), absence of cavernous sinus invasion (ASR 62.2% vs. 26.7%, p = 0.02; LTR 37.8% vs. 0%, p = 0.005), completely resected tumors (ASR 75.0% vs. 25.0%, p < 0.001; LTR 50.0% vs. 0%, p < 0.001). Patients achieving LTR had lower postoperative prolactin (4.5 vs. 28.0 ng/mL, p = 0.01). Median follow-up duration was 5.6 years, and median time to recurrence was 2.6 years. Recurrence was associated with higher peak prolactin (HR 1.003 per ng/mL, 95% CI: 1.001–1.01, p = 0.01), Knosp 2–4 tumors (HR 5.64, 95% CI: 1.40–22.80, p = 0.02), cavernous sinus invasion (HR 3.97, 95% CI: 1.15–13.64, p = 0.03), subtotal resection (HR 0.19 for GTR, 95% CI: 0.06–0.60, p = 0.01), and higher postoperative prolactin (HR 1.13 per ng/mL, 95% CI: 1.04–1.23, p = 0.01).

Conclusion

Tumor size, invasiveness, extent of resection, and prolactin levels are key predictors of remission and recurrence. These findings underscore risk-stratified decision-making and long-term surveillance.