{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:03Z","timestamp":1787025783025,"version":"build-2736575974"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Patients with growth hormone (GH)\u2013secreting pituitary adenomas (PAs) experience various symptoms and comorbidities, which can ultimately lead to increased mortality. This study aimed to develop and validate a machine learning (ML) model for predicting long-term outcomes in patients with GH-secreting PAs following endonasal transsphenoidal surgery (ETS).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors conducted a retrospective three-institution cohort study that included patients with GH-secreting PAs treated with ETS between 2013 and 2023. Clinical, radiological, and biochemical data were collected. The main outcome of interest was the intervention-free rate (IFR) after primary ETS. Supervised ML algorithms, including decision trees and random forests, were developed to predict the IFR. Model performance was evaluated using area under the receiver operating characteristic curve (AUROC) and Shapley Additive Explanations (SHAP) values.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The median follow-up for 100 patients with GH-secreting PAs (53% female) was 64 months (range 1\u2013130 months). Additional intervention for persistent or recurrent acromegaly was required in 32% of patients. Following primary ETS alone, the 3-year IFR was 70% and the 5-year IFR was 67%. Multiple ML models were developed and evaluated using AUROCs. The decision tree analysis achieved an accuracy of 81% and emphasized the importance of both gross-total resection (GTR) and patient age in determining the long-term IFR. To better understand the factors that contributed to model performance, SHAP analysis was applied to the best-performing model. The SHAP dependence plots showed that key factors associated with a longer IFR included tumor size < 9 mm, GTR, patient age > 65 years, and Knosp grade 0.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This ML model offers a more nuanced and potentially more accurate approach to identify patients more likely to develop recurrent or persistent acromegaly following primary ETS and require additional treatment. Following external validation, this ML model could improve personalized treatment planning and follow-up strategies and enhance patient care and resource allocation in clinical practice.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.4.focus2597","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T02:14:52Z","timestamp":1751336092000},"page":"E10","source":"Crossref","is-referenced-by-count":2,"title":["A supervised machine learning approach for predicting the need for postsurgical intervention in acromegaly"],"prefix":"10.3171","volume":"59","author":[{"given":"Yuki","family":"Shinya","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Karim","family":"Ghaith","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukwoo","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine S.","family":"Herndon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandhya R.","family":"Palit","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Saez-Alegre","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin A.","family":"Morshed","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Pinheiro Neto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. D.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Nat Rev Endocrinol","first-page":"552","article-title":"A consensus statement on acromegaly therapeutic outcomes","volume":"14","author":"Melmed S","year":"2018","unstructured":"Melmed S, Bronstein MD, Chanson P, A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018;14(9):552\u2013561."},{"issue":"11","key":"b2","series-title":"J Clin Endocrinol Metab","first-page":"3933","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson L","year":"2014","unstructured":"Katznelson L, Laws ER Jr, Melmed S, Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933\u20133951."},{"issue":"8","key":"b3","series-title":"J Clin Endocrinol Metab","first-page":"3190","article-title":"Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission","volume":"98","author":"Starke RM","year":"2013","unstructured":"Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr. Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab. 2013;98(8):3190\u20133198."},{"issue":"7","key":"b4","series-title":"J Clin Endocrinol Metab","first-page":"3141","article-title":"A consensus on criteria for cure of acromegaly","volume":"95","author":"Giustina A","year":"2010","unstructured":"Giustina A, Chanson P, Bronstein MD, A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab. 2010;95(7):3141\u20133148."},{"issue":"9","key":"b5","series-title":"J Endocrinol Invest","first-page":"2269","article-title":"Recurrence in acromegaly: two tertiary centers experience and review of the literature","volume":"47","author":"Cremaschi A","year":"2024","unstructured":"Cremaschi A, Sala E, Lavezzi E, Recurrence in acromegaly: two tertiary centers experience and review of the literature. J Endocrinol Invest. 2024;47(9):2269\u20132277."},{"issue":"11","key":"b6","series-title":"Acta Neurochir (Wien)","first-page":"2193","article-title":"Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications","volume":"159","author":"Chen CJ","year":"2017","unstructured":"Chen CJ, Ironside N, Pomeraniec IJ, Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir (Wien). 2017;159(11):2193\u20132207."},{"issue":"1","key":"b7","series-title":"Endocr Rev","first-page":"268","article-title":"Systemic complications of acromegaly and the impact of the current treatment landscape: an update","volume":"40","author":"Gadelha MR","year":"2019","unstructured":"Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic complications of acromegaly and the impact of the current treatment landscape: an update. 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Pituitary. 2021;24(1):53\u201361."},{"key":"b10","series-title":"Front Endocrinol (Lausanne)","first-page":"643","article-title":"Development and interpretation of multiple machine learning models for predicting postoperative delayed remission of acromegaly patients during long-term follow-up","volume":"11","author":"Dai C","year":"2020","unstructured":"Dai C, Fan Y, Li Y, Development and interpretation of multiple machine learning models for predicting postoperative delayed remission of acromegaly patients during long-term follow-up. Front Endocrinol (Lausanne). 2020;11:643."},{"issue":"3","key":"b11","series-title":"Pituitary","first-page":"486","article-title":"Machine learning as a clinical decision support tool for patients with acromegaly","volume":"25","author":"Sulu C","year":"2022","unstructured":"Sulu C, Bekta\u015f AB, \u015eahin S, Machine learning as a clinical decision support tool for patients with acromegaly. Pituitary. 2022;25(3):486\u2013495."},{"issue":"4","key":"b12","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp E","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610\u2013618."},{"issue":"4","key":"b13","series-title":"J Neurosurg","first-page":"1043","article-title":"Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study","volume":"132","author":"Little AS","year":"2020","unstructured":"Little AS, Kelly DF, White WL, Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. J Neurosurg. 2020;132(4):1043\u20131053."},{"issue":"1","key":"b14","series-title":"Nat Methods","first-page":"5","article-title":"Machine learning: supervised methods","volume":"15","author":"Bzdok D","year":"2018","unstructured":"Bzdok D, Krzywinski M, Altman N. 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Int J Comput Appl. 2012;43(8):6\u201312."},{"issue":"6","key":"b22","series-title":"J Chem Inf Comput Sci","first-page":"1947","article-title":"Random forest: a classification and regression tool for compound classification and QSAR modeling","volume":"43","author":"Svetnik V","year":"2003","unstructured":"Svetnik V, Liaw A, Tong C, Culberson JC, Sheridan RP, Feuston BP. Random forest: a classification and regression tool for compound classification and QSAR modeling. J Chem Inf Comput Sci. 2003;43(6):1947\u20131958."},{"key":"b23","series-title":"Random Forests with R","first-page":"33","article-title":"Random forests","author":"Genuer R","year":"2020","unstructured":"Genuer R, Poggi JM. Random forests. In: Random Forests with R. 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Rev Endocr Metab Disord. 2020;21(4):667\u2013678."},{"issue":"3","key":"b26","series-title":"J Clin Endocrinol Metab","first-page":"909","article-title":"Age- and sex-specific differences as predictors of surgical remission among patients with acromegaly","volume":"103","author":"Park SH","year":"2018","unstructured":"Park SH, Ku CR, Moon JH, Kim EH, Kim SH, Lee EJ. Age- and sex-specific differences as predictors of surgical remission among patients with acromegaly. J Clin Endocrinol Metab. 2018;103(3):909\u2013916."},{"issue":"1","key":"b27","series-title":"Pituitary","first-page":"1","article-title":"A Pituitary Society update to acromegaly management guidelines","volume":"24","author":"Fleseriu M","year":"2021","unstructured":"Fleseriu M, Biller BMK, Freda PU, A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021;24(1):1\u201313."},{"issue":"e882","key":"b28","series-title":"World Neurosurg","first-page":"e890","article-title":"A novel preoperative score to predict long-term biochemical remission in patients with growth-hormone secreting pituitary adenomas","volume":"182","author":"Cohen-Cohen S","year":"2024","unstructured":"Cohen-Cohen S, Rindler R, Botello Hernandez E, A novel preoperative score to predict long-term biochemical remission in patients with growth-hormone secreting pituitary adenomas. World Neurosurg. 2024;182(e882):e890."},{"issue":"7","key":"b29","series-title":"Endocr Pract","first-page":"668","article-title":"Necessity of multimodal treatment of acromegaly and outcomes","volume":"24","author":"Donegan DM","year":"2018","unstructured":"Donegan DM, Iniguez-Ariza N, Sharma A, Necessity of multimodal treatment of acromegaly and outcomes. 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Nat Rev Endocrinol. 2018;14(9):552\u2013561."},{"issue":"11","key":"b2","series-title":"J Clin Endocrinol Metab","first-page":"3933","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson L","year":"2014","unstructured":"Katznelson L, Laws ER Jr, Melmed S, Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933\u20133951."},{"issue":"8","key":"b3","series-title":"J Clin Endocrinol Metab","first-page":"3190","article-title":"Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission","volume":"98","author":"Starke RM","year":"2013","unstructured":"Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr. Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. 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