SIGNIFICANCE OF PROLIFERATING CELL NUCLEAR ANTIGEN INDEX IN PREDICTING PITUITARY-ADENOMA RECURRENCE

被引:125
作者
HSU, DW
HAKIM, F
BILLER, BMK
DELAMONTE, S
ZERVAS, NT
KLIBANSKI, A
HEDLEYWHYTE, ET
机构
[1] MASSACHUSETTS GEN HOSP,DIV NEUROPATHOL,BOSTON,MA 02114
[2] MASSACHUSETTS GEN HOSP,DIV NEUROSURG,BOSTON,MA 02114
[3] MASSACHUSETTS GEN HOSP,DIV NEUROENDOCRINE,BOSTON,MA 02114
[4] HARVARD UNIV,SCH MED,DEPT PATHOL,BOSTON,MA 02115
[5] HARVARD UNIV,SCH MED,DEPT SURG,BOSTON,MA 02115
[6] HARVARD UNIV,SCH MED,DEPT MED,BOSTON,MA 02115
关键词
PROLIFERATING CELL NUCLEAR ANTIGEN; PITUITARY ADENOMA; TUMOR RECURRENCE; IMMUNOCYTOCHEMISTRY;
D O I
10.3171/jns.1993.78.5.0753
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The recurrence rate of pituitary adenomas has been reported to be as high as 10% to 35% despite their generally benign nature. A monoclonal antibody directed against proliferating cell nuclear antigen (PCNA) was used to investigate whether the proliferative index might help to predict adenoma recurrence. This antigen is a nuclear protein identified as the auxiliary protein of deoxyribonucleic acid polymerase delta, and its gene expression correlates with cell proliferation. The authors studied 30 patients with recurrent pituitary adenomas, 32 with nonrecurrent adenomas, and seven normal pituitary tissue samples. The mean interval to recurrence (+/- standard error of the mean) was 5.3 +/- 0.7 years. The age- and sex-matched nonrecurrent group had a mean follow-up period of 6.6 +/- 0.3 years without clinical recurrence. Mean percentages of PCNA-positive tumor nuclei in both the initial and the second surgical specimens of the recurrent adenomas (13.45% +/- 3.02% and 19.56% +/- 3.66%, respectively) were significantly higher than that of the nonrecurrent group (2.49% +/- 1.21%). In addition, recurrent tumors had a higher PCNA index than the initial tumors in the same patients. Normal anterior pituitary gland tissue had a significantly lower mean PCNA index (0.12% +/- 0.11%) than either patient group. Stepwise multivariate regression analysis indicated that factors which collectively cor-related significantly with recurrence were: high PCNA index, large tumor size, extrasellar extension, and incomplete surgical excision. The PCNA nuclear count was not associated with age, sex, or hormone hypersecretion, but was higher in macro- than in microadenomas, in tumors with extrasellar extension, and in those incompletely excised. A higher PCNA index also correlated with a shorter disease-free interval. The authors conclude that evaluation of the PCNA index assists in predicting the likelihood of pituitary adenoma recurrence.
引用
收藏
页码:753 / 761
页数:9
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