Research Article Prognostic Value of Invasion, Markers of Proliferation, and Classification of Giant Pituitary Tumors, in a Georeferred Cohort in Brazil of 50 Patients, with a Long-Term Postoperative Follow-Up
Juliano Coelho de Oliveira Zakir,1 Luiz Augusto Casulari,1 José Wilson Corrêa Rosa,2 João Willy Corrêa Rosa,2 Paulo Andrade de Mello,3 Albino Verçosa de Magalhães,4 and Luciana Ansaneli Naves1
1 Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
2 Institute of Geosciences, University of Brasilia, Brasilia, Brazil
3 Department of Neurosurgery, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
4 Department of Pathology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
Received 27 November 2015; Revised 9 March 2016; Accepted 30 June 2016
Academic Editor: Andrea G. Lania Copyright © 2016 Juliano Coelho de Oliveira Zakir et al.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Although some pituitary adenomas may have an aggressive behavior, the vast majority are benign.There are still controversies about predictive factors regarding the biological behavior of these particular tumors. This study evaluated potential markers of invasion and proliferation compared to current classification patterns and epidemiogeographical parameters.The study included 50 patients, operated on for tumors greater than 30 mm, with a mean postoperative follow-up of 15.2 ± 4.8 years. Pituitary magnetic resonance was used to evaluate regrowth, invasion, and extension to adjacent tissue. Three tissue biomarkers were analyzed: p53, Ki-67, and c-erbB2. Tumors were classified according to a combination of histological and radiological features, ranging from noninvasive and nonproliferative (grade 1A) to invasive-proliferative (grade 2B). Tumors grades 2A and 2B represented 42% and 52%, respectively. Ki-67 (⯑ = 0.23) and c-erbB2 (⯑ = 0.71) had no significant relation to tumor progression status. P53 (⯑ = 0.003), parasellar invasion (⯑ = 0.03), and classification, grade 2B (⯑ = 0.01), were associated with worse clinical outcome. Parasellar invasion prevails as strong predictive factor of tumor recurrence. Severe suprasellar extension should be considered as invasion parameter and could impact prognosis. No environmental factors or geographical cluster were associated with tumor behavior.