{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:52:52Z","timestamp":1774605172117,"version":"3.50.1"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify independent risk factors for pituitary adenoma recurrence after transsphenoidal surgery and construct and validate a nomogram for recurrence risk quantification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively collected clinical data of 469 patients with pituitary adenomas from Fuzhou 900 Hospital and Huashan Hospital of Fudan University. LASSO regression was applied to screen potential predictive factors, followed by multivariate Logistic regression to identify independent prognostic factors. Nomograms were subsequently constructed to evaluate the model's discriminative ability, calibration, and clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Recurrence occurred in 64 cases (13.65%). Multivariate analysis confirmed modified Knosp classification (grades 3B\u20134), clival invasion, and subtotal resection as independent risk factors (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009\n                      <jats:italic>&amp;lt;<\/jats:italic>\n                      \u20090.05). The model had AUC 0.905 [95%CI (0.8254, 0.9847)], C-index 0.905, sensitivity 85%, specificity 86.4%, with good calibration and clinical net benefits (DCA: 0.05\u20130.90 threshold).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The nomogram, which is the first to integrate clival invasion with modified Knosp classification and extent of resection, effectively predicts pituitary adenoma recurrence after transsphenoidal surgery and shows promising clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1784374","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:59:35Z","timestamp":1774601975000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factor identification and nomogram-based predictive model development for recurrence of pituitary adenomas following transsphenoidal surgery: a dual-center retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xingjian","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Neurovascular Diseases","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenxian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Bengbu Medical University","place":["Bengbu, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengwei","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jinjiang Municipal Hospital (Shanghai Sixth People\u2019s Hospital Fujian Branch)","place":["Jinjiang\/Quanzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuyang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Neurovascular Diseases","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiansheng","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shousen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Neurovascular Diseases","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, 900th Hospital of PLA Joint Logistic Support Force","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Neurovascular Diseases","place":["Fuzhou, Fujian, China"]},{"name":"Department of Neurosurgery, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1056\/NEJMra1810772","article-title":"Pituitary-Tumor endocrinopathies","volume":"382","author":"Melmed","year":"2020","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1007\/s12022-022-09703-7","article-title":"Overview of the 2022 WHO classification of pituitary tumors","volume":"33","author":"Asa","year":"2022","journal-title":"Endocr Pathol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1001\/jama.2016.19699","article-title":"Diagnosis and treatment of pituitary adenomas: a review","volume":"317","author":"Molitch","year":"2017","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"956345","DOI":"10.3389\/fsurg.2022.956345","article-title":"Analysis of neuroendoscopy for the treatment of macroadenomas and giant pituitary adenomas","volume":"9","author":"Wu","year":"2022","journal-title":"Front Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1038\/s41574-021-00550-w","article-title":"Aggressive pituitary tumors and pituitary carcinomas","volume":"17","author":"Raverot","year":"2021","journal-title":"Nat Rev Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e70098","DOI":"10.1002\/iid3.70098","article-title":"Advancements in molecular diagnosis and pharmacotherapeutic strategies for invasive pituitary adenomas","volume":"12","author":"Xu","year":"2024","journal-title":"Immun Inflamm Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1093\/neuonc\/now130","article-title":"Management of hormone-secreting pituitary adenomas","volume":"19","author":"Mehta","year":"2017","journal-title":"Neuro Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1159\/000339823","article-title":"Natural history of postoperative nonfunctioning pituitary adenomas: a systematic review and meta-analysis","volume":"96","author":"Chen","year":"2012","journal-title":"Neuroendocrinology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1038\/nrendo.2011.12","article-title":"Management of cushing disease","volume":"7","author":"Tritos","year":"2011","journal-title":"Nat Rev Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"803","DOI":"10.3171\/2014.12.JNS141083","article-title":"Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification","volume":"122","author":"Micko","year":"2015","journal-title":"J Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1080\/07853890.2022.2160490","article-title":"A novel nomogram for predicting the decision to delayed extubation after thoracoscopic lung cancer surgery","volume":"55","author":"Tong","year":"2023","journal-title":"Ann Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1115291","DOI":"10.3389\/fimmu.2023.1115291","article-title":"Development and validation of a radiomics-based nomogram for predicting a major pathological response to neoadjuvant immunochemotherapy for patients with potentially resectable non-small cell lung cancer","volume":"14","author":"Liu","year":"2023","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1007\/s00701-014-1993-0","article-title":"Nonfunctioning pituitary adenomas: association of ki-67 and HMGA-1 labeling indices with residual tumor growth","volume":"156","author":"\u0160te\u0148o","year":"2014","journal-title":"Acta Neurochir (Wien)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"793337","DOI":"10.3389\/fendo.2021.793337","article-title":"Analysis of related factors of tumor recurrence or progression after transnasal sphenoidal surgical treatment of large and giant pituitary adenomas and establish a nomogram to predict tumor prognosis","volume":"12","author":"Chen","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/cen.14127","article-title":"Current perspectives on recurrent pituitary adenoma: the role and timing of surgery vs adjuvant treatment","volume":"92","author":"Hayhurst","year":"2020","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"906","DOI":"10.5137\/1019-5149.JTN.11288-14.1","article-title":"Endoscopic endonasal transsphenoidal treatment for acromegaly: 2010 consensus criteria for remission and predictors of outcomes","volume":"24","author":"Yildirim","year":"2014","journal-title":"Turk Neurosurg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.jocn.2017.07.015","article-title":"Large and giant pituitary adenoma resection by microscopic trans-sphenoidal surgery: surgical outcomes and complications in 123 consecutive patients","volume":"44","author":"Karki","year":"2017","journal-title":"J Clin Neurosci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1080\/00207454.2023.2203836","article-title":"Pre- and post-clinical-radiological and surgical evaluation of patients with pituitary adenoma and metabolic syndrome","volume":"134","author":"Flores-Rabasa","year":"2024","journal-title":"Int J Neurosci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.ecl.2020.05.001","article-title":"World health ozganization 2017 classification of pituitary tumors","volume":"49","author":"Lopes","year":"2020","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B20","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1055\/s-0036-1592081","article-title":"Ectopic pituitary adenomas presenting as sphenoid or clival lesions: case series and management recommendations","volume":"78","author":"Tajudeen","year":"2017","journal-title":"J Neurol Surg B Skull Base"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/8371697","article-title":"Clival ectopic pituitary adenoma mimicking a chordoma: case report and review of the literature","volume":"2016","author":"Karras","year":"2016","journal-title":"Case Rep Neurol Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"785","DOI":"10.3174\/ajnr.A2364","article-title":"Clival invasion on multi-detector CT in 390 pituitary macroadenomas: correlation with sex, subtype and rates of operative complication and recurrence","volume":"32","author":"Chen","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.3171\/2016.12.JNS161920","article-title":"Clinical outcomes of an endoscopic transclival and transpetrosal approach for primary skull base malignancies involving the clivus","volume":"128","author":"Kim","year":"2018","journal-title":"J Neurosurg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1016\/j.wneu.2015.08.029","article-title":"Endoscopic endonasal transclival resection of a brainstem cavernoma: a detailed account of our technique and comparison with the literature","volume":"84","author":"Linsler","year":"2015","journal-title":"World Neurosurg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1227\/00006123-199310000-00008","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp","year":"1993","journal-title":"Neurosurgery"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fonc.2021.807040","article-title":"Radiological knosp, revised-knosp, and hardy\u2013wilson classifications for the prediction of surgical outcomes in the endoscopic endonasal surgery of pituitary adenomas: study of 228 cases","volume":"11","author":"Araujo-Castro","year":"2022","journal-title":"Front Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s40618-020-01296-4","article-title":"Predictive model of surgical remission in acromegaly: age, presurgical GH levels and knosp grade as the best predictors of surgical remission","volume":"44","author":"Araujo-Castro","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02688697.2021.1884186","article-title":"Ki-67 labeling Index and knosp classification of pituitary adenomas","volume":"27","author":"Yuhan","year":"2021","journal-title":"Br J Neurosurg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s13023-019-1038-0","article-title":"Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for cushing\u2019s disease: surgical outcome, mortality, and complications","volume":"14","author":"Broersen","year":"2019","journal-title":"Orphanet J Rare Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/neuros\/nyx020","article-title":"Long-Term endocrine outcomes following endoscopic endonasal transsphenoidal surgery for acromegaly and associated prognostic factors","volume":"81","author":"Babu","year":"2017","journal-title":"Neurosurgery"},{"key":"B31","doi-asserted-by":"publisher","first-page":"535","DOI":"10.3171\/2019.11.JNS192457","article-title":"Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas","volume":"134","author":"Gerges","year":"2020","journal-title":"J Neurosurg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"6921","DOI":"10.1097\/JS9.0000000000002889","article-title":"Comparison of endoscopic versus microscopic transsphenoidal surgery in patients with pituitary adenomas: a propensity score matched study","volume":"111","author":"Zhang","year":"2025","journal-title":"Int J Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e1022","DOI":"10.1002\/mgg3.1022","article-title":"Identification of a novel somatic mutation of POU6F2 by whole-genome sequencing in prolactinoma","volume":"7","author":"Miao","year":"2019","journal-title":"Mol Genet Genomic Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"107157","DOI":"10.1016\/j.jbc.2024.107157","article-title":"The aryl hydrocarbon receptor-interacting protein in cancer and immunity: beyond a chaperone protein for the dioxin receptor","volume":"300","author":"Kazzaz","year":"2024","journal-title":"J Biol Chem"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1784374\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T08:59:36Z","timestamp":1774601976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1784374\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":34,"alternative-id":["10.3389\/fsurg.2026.1784374"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1784374","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"article-number":"1784374"}}