Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients
Résumé
Introduction Given the new therapeutic options in acromeg-aly, it seemed important to evaluate the outcome of operated acromegalic patients today. Objective To analyse the characteristics and short-and long-term surgical outcome of patients who underwent transsphenoi-dal surgery for a growth hormone (GH)-secreting adenoma in our centre and to determine predictive factors of remission. Design and patients This retrospective 10-year study included 115 newly diagnosed acromegalic patients operated on at Timone University Hospital, Marseille, France, between 1997 and 2007. Measurements Initial and long-term outcomes were evaluated using stringent and current remission criteria, associating GH nadir after oral glucose tolerance test <0Á4 lg/l and normal insulin like growth factor-1 (IGF-1) at 3 months, and a normal IGF-1 at the end of follow-up (52Á4 ± 36Á8 months, median 41 months, range 6Á7–135Á4 months, n = 99). Results At the end of follow-up, 90Á9% of patients had controlled disease. Overall, 49Á5% of patients were in long-term remission after surgery alone, and only 2Á0% of patients experienced recurrent disease. Multivariate predictors of 3-month remission included mean GH at diagnosis (P = 0Á033), tumour invasion (P = 0Á013) and surgeon report of incomplete or uncertain macroscopic resection (P = 0Á003 and P = 0Á047, respectively). Multivariate predictors at diagnosis of long-term remission included mean GH level (P = 0Á048), adenoma size (P = 0Á007) and absence of pituitary deficit (P = 0Á026). Conclusions In long-term follow-up after surgery of acromeg-aly, half of the patients achieved remission after surgery alone and more than 90% had their disease controlled. With stringent 3-month remission criteria, recurrence was rare.
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