Saturday, June 22, 2024

New Pituitary Tumor Classification Enhances Prognostic Accuracy

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The recent update in the World Health Organization (WHO) classification for pituitary neuroendocrine tumors (PitNET) in 2022 has significantly refined the diagnostic criteria, emphasizing the role of transcription factors (TF). This study explores the clinical utility of the 2022 classification compared to the 2017 version in patients with non-functioning PitNET (NF-PitNET) at Queen Mary Hospital, Hong Kong. The reclassification and subsequent analysis provide critical insights into tumor behavior and prognosis, potentially guiding more effective treatment strategies.

Methodology and Patient Cohort

The study included 113 NF-PitNET patients who underwent surgical resection between 2010 and 2021. Surgical specimens collected were re-stained for three key TFs: steroidogenic factor (SF-1), T-box family member TBX19 (TPIT), and POU class 1 homeobox 1 (Pit-1). Logistic and Cox regression analyses were utilized to correlate different NF-PitNET subtypes with tumor-related outcomes.

Significant Findings

Applying the 2022 WHO classification, SF-1-lineage tumors constituted the majority (58.4%), followed by TPIT-lineage (18.6%), tumors with no distinct lineage (16.8%), and Pit-1-lineage (6.2%). Despite fewer classification entities than in 2017, marked differences in disease-free survival among these subtypes were observed, notably between SF-1-lineage tumors and those without distinct lineage.

In multivariable Cox regression analysis, tumors without distinct lineage emerged as independent predictors of residual or recurrent disease alongside tumor volume. Specifically, these non-distinct lineage tumors exhibited a hazard ratio (HR) of 3.02, indicating a higher likelihood of adverse outcomes.

Inferences for Clinical Practice

The updated WHO classification provides:

  • Enhanced accuracy in predicting disease-free survival across different PitNET subtypes.
  • Identification of SF-1-lineage tumors as having a significantly better prognosis compared to non-distinct lineage tumors.
  • Utility in stratifying patients for tailored treatment approaches based on TF lineage, potentially improving clinical outcomes.

This study underscores the clinical relevance of the 2022 WHO classification in effectively subtyping NF-PitNET tumors, offering a robust framework for understanding tumor behavior and guiding prognosis.

Original Article: Front Endocrinol (Lausanne). 2024 May 2;15:1368944. doi: 10.3389/fendo.2024.1368944. eCollection 2024.

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