{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T01:18:37Z","timestamp":1778721517374,"version":"3.51.4"},"reference-count":72,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Postoperative deserved outcomes in acromegalic patients are to normalize serum insulin-like growth factor (IGF-1), reduce the tumoral mass effect, improve systemic comorbidities, and reverse metabolic alterations. Pituitary neuroendocrine tumors (PitNET) are characterized to present a heterogeneous behavior, and growth hormone (GH)-secreting PitNET is not an exception. Promptly determining which patients are affected by more aggressive tumors is essential to guide the optimal postoperative decision-making process [prognostic-based approach]. From 2006 to 2019, 394 patients affected by PitNET were intervened via endoscopic endonasal transsphenoidal approach by the same senior surgeon. A total of 44 patients that met the criteria to be diagnosed as acromegalic and were followed up at least for 24 months (median of 66 months (26\u2013156) were included in the present study. Multiple predictive variables [age, gender, preoperative GH and IGF-1 levels, maximal tumor diameter, Hardy\u2019s and Knosp\u2019s grade, MRI. T2-weighted tumor intensity, cytokeratin expression pattern, and clinicopathological classification] were evaluated through uni- and multivariate statistical analysis. Sparse probability of long-term remission was related to younger age, higher preoperative GH and- or IGF-1, group 2b of the clinicopathological classification, and sparsely granulated cytokeratin expression pattern. Augmented recurrence risk was related to elevated preoperative GH levels, tumor MRI T2-weighted hyperintensity, and sparsely granulated cytokeratin expression pattern. Finally, elevated risk for reintervention was related to group 2b of the clinicopathological classification, Knosp\u2019s grade IV, and tumor MRI T2-weighted hyperintensity. In this study, the authors determined younger age, higher preoperative GH and- or IGF-1 levels, group 2b of the clinicopathological classification, Knosp\u2019s grade IV, MRI T2-weighted tumor hyperintensity and sparsely granulated cytokeratin expression pattern are related to worse postoperative outcomes in long-term follow-up patients affected with GH-secreting PitNET.<\/jats:p>","DOI":"10.3390\/cancers15010267","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T03:00:59Z","timestamp":1672628459000},"page":"267","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["The Prognostic-Based Approach in Growth Hormone-Secreting Pituitary Neuroendocrine Tumors (PitNET): Tertiary Reference Center, Single Senior Surgeon, and Long-Term Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0003-3235","authenticated-orcid":false,"given":"Abel","family":"Ferr\u00e9s","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1209-7535","authenticated-orcid":false,"given":"Lu\u00eds","family":"Reyes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Di Somma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomaz","family":"Topczewski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra","family":"Mosteiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Guizzardi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Policlinico Federico II, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Halperin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Endocrinology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia","family":"Hanzu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Endocrinology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mireia","family":"Mora","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Endocrinology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2557-6017","authenticated-orcid":false,"given":"Isam","family":"Alobid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Otorhinolaryngology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iban","family":"Aldecoa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Anatomical Pathology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N\u00faria","family":"Bargall\u00f3","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Department of Radiology, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joaquim","family":"Ense\u00f1at","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: An Endocrine Society Clinical Practice Guideline","volume":"99","author":"Katznelson","year":"2014","journal-title":"J. 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