摘要
目的探讨神经内镜经鼻蝶入路切除垂体腺瘤术后复发的相关影响因素及其对复发的预测价值。方法回顾性分析646例2015年1月至2018年1月于兰州大学第二医院神经外科行神经内镜经鼻蝶垂体腺瘤切除术患者的临床资料。根据末次随访情况将患者分为未复发组和复发组。采用单因素和多因素logistic回归法分析影响术后复发的相关因素;采用受试者工作特征曲线(ROC)评估相关危险因素对复发的预测价值,并采用Bootstrap自助抽样法(抽取1000次)作为验证集进行内部验证。结果646例患者术后的随访时间为(48.4±16.6)个月(28.6~57.6个月),其中82例(12.7%)患者复发。多因素logistic回归分析结果显示,侵袭性肿瘤(OR=6.616,95%CI:3.287~13.317)、肿瘤增殖(OR=8.842,95%CI:4.390~17.807)、肿瘤最大直径大(OR=7.878,95%CI:4.530~13.699)是影响肿瘤术后复发的危险因素,而肿瘤全切除(OR=0.019,95%CI:0.003~0.100)是术后复发的保护性因素(均P<0.01)。ROC结果显示,上述因素预测患者术后复发的曲线下面积(AUC)为0.931(95%CI:0.895~0.966),灵敏度为81.71%,特异度为94.86%。内部验证显示AUC为0.929(95%CI:0.893~0.964)。结论肿瘤直径大侵袭性肿瘤、肿瘤增殖及肿瘤不完全切除是神经内镜经鼻蝶入路垂体腺瘤切除术后复发的危险因素,其预测肿瘤复发的效能较高。
Objective To explore the factors and their predictive values related to the recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenomas.Methods A retrospective analysis was conducted on the clinical data of 646 patients who underwent endoscopic endonasal transsphenoidal resection of pituitary adenomas at the Department of Neurosurgery,Lanzhou University Second Hospital from January 2015 to January 2018.According to the latest follow-up,the patients were divided into non-recurrence group and recurrence group.Univariate and multivariate logistic regression methods were used to analyze the relevant factors affecting postoperative recurrence;receiver operating characteristic curve(ROC)was used to assess the predictive values of related risk factors for recurrence,and Bootstrap self-sampling method(1000 times)was used as the verification set for internal verification.Results The postoperative follow-up time of 646 patients was 48.4±16.6 months(28.6-57.6 months),of which 82(12.7%)patients relapsed.The results of multivariate logistic regression analysis showed that tumor invasiveness(OR=6.616,95% CI:3.287-13.317),tumor proliferation(OR=8.842,95% CI:4.390-17.807),and large maximum tumor diameter(OR=7.878,95% CI:4.530-13.699)were risk factors for tumor recurrence after surgery,while total tumor resection(OR=0.019,95% CI:0.003-0.100)was a protective factor for postoperative recurrence(all P<0.01).ROC results showed that the area under the curve(AUC)of the above factors predicting postoperative recurrence of patients was 0.931(95% CI:0.895-0.966),the sensitivity was 81.71%,and the specificity was 94.86%.Internal verification showed that AUC was 0.929(95% CI:0.893-0.964).Conclusion Larger maximum tumor diameter,tumor invasiveness,tumor proliferation and incomplete tumor resection are the risk factors of recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenomas,which have high predictive values for tumor recurrence.
作者
杨强
杨虎
贾艳飞
雒晓东
李强
Yang Qiang;Yang Hu;Jia Yanfei;Luo Xiaodong;Li Qiang(Department of Neurosurgery,Lanzhou University Second Hospital,Lanzhou 730030,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第9期928-932,共5页
Chinese Journal of Neurosurgery
基金
兰州市人才创新创业项目(2020-RC-50)
兰州市城关区科技计划项目(2020-2-2-11)。
关键词
垂体肿瘤
自然腔道内镜手术
复发
危险因素
预测
Pituitary adenomas
Natural orifice transluminal endoscopic surgery
Recurrence
Risk factors
Prediction
