World neurosurgery 2017 07 12() pii S1878-8750(17)31113-0
To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing’s disease (CD).
One hundred forty-seven consecutive adult patients with CD who underwent primary trans-sphenoidal surgery between 1998 and 2014 were included in this study. Eighty-two were followed up in Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. The patients were requested to attend a long-term remission assessment; 55 could be contacted and data for the remaining 27 patients’ last visit to the outpatient clinics were reviewed for early and late remission. Six patients were excluded from the study. Magnetic resonance imaging (MRI) findings and pathologic results including mitosis, Ki-67 levels and P53 in immunostaining of all patients were evaluated.
Data of 82 patients with CD with an average age of 36 years [IQR: 29-47] years were analyzed with a mean follow up 7.5 years [IQR: 5-10]. Overall initial remission rates were 72.3% after TSS. Among the 82 patients, 16 patients had Gamma-knife radiosurgery and 7 patients underwent adrenalectomy. After these additional treatments, the long-term remission rate was found as 69.7%. The highest remission rates were with microadenomas. Recurrence was most frequently seen in patients without tumor evidence on MRI. Patients with high Ki-67 levels had higher recurrence rates in long-term follow-up (p=0.02).
Life-long follow-up for patients with CD seems essential. Undetectable tumors on MRI before TSS and high Ki-67 immunopositivity were found as risk factors for tumor recurrence.