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Purpose <p>This study evaluates surgical outcomes for acromegaly at King’s College Hospital(2012–2022), focusing on predictive factors for surgical cure. A novel radiological metric, the MI Ratio, is introduced to enhance the prediction of clinical remission post-surgery, providing a more accurate prognosis and informing treatment planning.</p> Methods <p>This single-centre cohort study involved a retrospective analysis of prospectively collected data from a UK tertiary referral centre. Included were patients with histologically proven somatotroph tumours who underwent endoscopic trans-sphenoidal surgery (TSS) between 2012 and 2022. Exclusions were made for incomplete data or lost follow-up. Patient demographics, tumour characteristics, radiological parameters, and biochemical markers were analysed. The MI Ratio was defined as the distance from the midline to the lateral maximum of a tumour, divided by the distance between the two cavernous carotid arteries on coronal MRI.</p> Results <p>Out of 157 patients, 150 met the inclusion criteria. Using the 2018 consensus OGTT nadir &lt; 0.40&#xa0;ng/mL, microadenomas had a higher surgical cure rate (72%) compared to macroadenomas (48%), with an overall cure rate of 53%. Significant predictors of surgical cure included the MI Ratio (<i>p</i> &lt; 0.001), microadenomas (<i>p</i> = 0.022), Knosp score &lt; 2 (<i>p</i> = 0.012), immediate post-operative GH level (<i>p</i> = 0.016), and patient gender (<i>p</i> = 0.005). Pre-operative medical management did not significantly impact surgical remission (<i>p</i> = 0.19), while pre-operative GH level approached significance (<i>p</i> = 0.06). CV between operators for MI was &lt; 5% indicating minimal Interoperator variability.</p> Conclusions <p>This study is the first to describe the MI Ratio, demonstrating its utility in predicting surgical remission in acromegaly patients. A combination of radiological features, demographics, and hormone profiles can more accurately identify patients less likely to achieve surgical cure.</p>

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Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月8日

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  • Feras Fayez,
  • Ahmed Abougamil,
  • Francesca Vitulli,
  • James Knight,
  • Christoforos Syrris,
  • Oktay Genel,
  • Jonathan Shapey,
  • Eleni Maratos,
  • Nicholas Thomas,
  • Sinan Barazi

摘要

Purpose

This study evaluates surgical outcomes for acromegaly at King’s College Hospital(2012–2022), focusing on predictive factors for surgical cure. A novel radiological metric, the MI Ratio, is introduced to enhance the prediction of clinical remission post-surgery, providing a more accurate prognosis and informing treatment planning.

Methods

This single-centre cohort study involved a retrospective analysis of prospectively collected data from a UK tertiary referral centre. Included were patients with histologically proven somatotroph tumours who underwent endoscopic trans-sphenoidal surgery (TSS) between 2012 and 2022. Exclusions were made for incomplete data or lost follow-up. Patient demographics, tumour characteristics, radiological parameters, and biochemical markers were analysed. The MI Ratio was defined as the distance from the midline to the lateral maximum of a tumour, divided by the distance between the two cavernous carotid arteries on coronal MRI.

Results

Out of 157 patients, 150 met the inclusion criteria. Using the 2018 consensus OGTT nadir < 0.40 ng/mL, microadenomas had a higher surgical cure rate (72%) compared to macroadenomas (48%), with an overall cure rate of 53%. Significant predictors of surgical cure included the MI Ratio (p < 0.001), microadenomas (p = 0.022), Knosp score < 2 (p = 0.012), immediate post-operative GH level (p = 0.016), and patient gender (p = 0.005). Pre-operative medical management did not significantly impact surgical remission (p = 0.19), while pre-operative GH level approached significance (p = 0.06). CV between operators for MI was < 5% indicating minimal Interoperator variability.

Conclusions

This study is the first to describe the MI Ratio, demonstrating its utility in predicting surgical remission in acromegaly patients. A combination of radiological features, demographics, and hormone profiles can more accurately identify patients less likely to achieve surgical cure.