Lei Zhang1, Xiaojun Wu1, Yong Yan1, Jun Qian1, Yicheng Lu2, Chun Luo1. 1. Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China. 2. Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: doctoraladvisor@163.com.
Abstract
BACKGROUND: Several studies have investigated the biochemical remission rate of presurgical somatostatin analogs treatment on acromegaly, but the remission criteria were diversed and the results were contradicting. OBJECTIVE: Aim of this paper is to provide enhanced evidence for the effectiveness of preoperative SSA treatment to improve on surgical results of macroadenomas in acromegaly. DATA SOURCE: Literature is cited from the PubMed, Embase and Cochrane Library, dating from December, 1985 to August, 2013. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included patients with acromegaly caused by GH-secreting pituitary macroadenomas, patients pretreated with somatostatin analogs versus direct surgery and a stricter remission criteria defined as the GH nadir<1μg/l during an oral glucose tolerance test (OGTT) and the age- and sex- adjusted IGF-1 concentration was normal. Primary end points included Short term and long term postoperative biochemical remission. STUDY APPRAISAL AND SYNTHESIS METHODS: A total of 1421 publications were found by the electronic search. After full-text review, 8 were included in our study. 7 of them focus on the postoperative remission in short term; 3 of them focus on the outcomes in long term. For the analysis of the postoperative biochemical remission, a random effect model was used to account for differences. RESULTS: The meta analysis shows that patients in the SSA pretreatment groups have had a more significantly cure rate than those in the direct surgery groups (RR=1.72, 95%CI: 1.14-2.60, P=0.009) with a short term follow-up. Subgroup analysis proves benefit from lanreotide pretreated groups (RR=2.27, 95%CI: 1.34-3.84, P=0.002) but not octreotide pretreated groups (RR=1.51, 95%CI: 0.82-2.75, P=0.183). No significant differences appeared between the two groups (RR=1.03, 95%CI: 0.86-1.24, P=0.751) with a long term follow-up. LIMITATIONS: 2 Retrospective trial was included and most of the trials included was designed as single-center study. CONCLUSIONS: Based on the analysis of this paper, the preoperative SSA treatment was beneficial in the group with short-term follow-up, while it was not advantageous in the group with long-term follow-up. For the limitations in this study, to drawn more solid conclusions, further large, randomized, multi-center, and long-term follow-up trials were required.
BACKGROUND: Several studies have investigated the biochemical remission rate of presurgical somatostatin analogs treatment on acromegaly, but the remission criteria were diversed and the results were contradicting. OBJECTIVE: Aim of this paper is to provide enhanced evidence for the effectiveness of preoperative SSA treatment to improve on surgical results of macroadenomas in acromegaly. DATA SOURCE: Literature is cited from the PubMed, Embase and Cochrane Library, dating from December, 1985 to August, 2013. STUDY ELIGIBILITY CRITERIA: Eligibility criteria included patients with acromegaly caused by GH-secreting pituitary macroadenomas, patients pretreated with somatostatin analogs versus direct surgery and a stricter remission criteria defined as the GH nadir<1μg/l during an oral glucose tolerance test (OGTT) and the age- and sex- adjusted IGF-1 concentration was normal. Primary end points included Short term and long term postoperative biochemical remission. STUDY APPRAISAL AND SYNTHESIS METHODS: A total of 1421 publications were found by the electronic search. After full-text review, 8 were included in our study. 7 of them focus on the postoperative remission in short term; 3 of them focus on the outcomes in long term. For the analysis of the postoperative biochemical remission, a random effect model was used to account for differences. RESULTS: The meta analysis shows that patients in the SSA pretreatment groups have had a more significantly cure rate than those in the direct surgery groups (RR=1.72, 95%CI: 1.14-2.60, P=0.009) with a short term follow-up. Subgroup analysis proves benefit from lanreotide pretreated groups (RR=2.27, 95%CI: 1.34-3.84, P=0.002) but not octreotide pretreated groups (RR=1.51, 95%CI: 0.82-2.75, P=0.183). No significant differences appeared between the two groups (RR=1.03, 95%CI: 0.86-1.24, P=0.751) with a long term follow-up. LIMITATIONS: 2 Retrospective trial was included and most of the trials included was designed as single-center study. CONCLUSIONS: Based on the analysis of this paper, the preoperative SSA treatment was beneficial in the group with short-term follow-up, while it was not advantageous in the group with long-term follow-up. For the limitations in this study, to drawn more solid conclusions, further large, randomized, multi-center, and long-term follow-up trials were required.
Authors: Shaun J Kilty; Myriam G M Hunink; Lisa Caulley; Eline Krijkamp; Mary-Anne Doyle; Kednapa Thavorn; Fahad Alkherayf; Nick Sahlollbey; Selina X Dong; Jason Quinn; Stephanie Johnson-Obaseki; David Schramm Journal: Pituitary Date: 2022-08-27 Impact factor: 3.599
Authors: Alberto Acitores Cancela; Víctor Rodríguez Berrocal; Héctor Pian; Juan Salvador Martínez San Millán; Juan José Díez; Pedro Iglesias Journal: Hormones (Athens) Date: 2021-06-19 Impact factor: 2.885