{"doi":"10.1530/eje-22-0812","title":"Real-life clinical impact of a five-tiered classification of pituitary tumors","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Introduction</jats:title>\n                  <jats:p>Usually benign, pituitary tumors (PT) can be invasive and aggressive with a propensity to progress and/or recur. Trouillas's clinicopathological classification attempts to predict the evolutionary risk of a PT. In this study, we assessed the prognostic value of this classification in an independent patient cohort and analyzed its impact on treatment strategies.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and methods</jats:title>\n                  <jats:p>In this study, 607 patients operated on between 2008 and 2018 for a PT were included. Grading was established based on invasion, proliferative activity (Ki-67, mitotic index) and p53 positivity. The therapeutic management following surgery was analyzed. Progression-free survival (PFS) of the graded tumors was estimated (Kaplan–Meier method and log-rank test) and a multivariate analysis was performed (Cox regression model).</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Grading identified non-invasive PT without (grade 1a: 303 cases) or with proliferative activity (grade 1b: 53 cases) and invasive PT without (grade 2a: 202 cases) or with proliferative activity (grade 2b: 49 cases). The mean follow-up was 47 ± 30 months (median: 38 months). Progression/recurrence occurred in 127 cases. Grades were significant and independent predictors of PFS (P &amp;lt; 0.001) with a 4.8-fold higher risk of progression/recurrence in grade 2b as compared to grade 1a. As second-line therapy, gamma knife or conventional radiotherapy controlled tumor growth in 91.6 and 100% of cases, respectively, irrespective of the grade. Proliferative tumors exposed the patient to a 9.5-fold higher risk of having ≥3 adjuvant therapeutic lines as compared to non-proliferative tumors.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion</jats:title>\n                  <jats:p>Grading of a PT according to Trouillas's classification predicts its risk of progression and should advocate for a personalized therapeutic approach in invasive and proliferative tumors.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Significance statement</jats:title>\n                  <jats:p>This is the first study to assess, on a cohort of 607 well-characterized patients, the real-life therapeutic impact of the five-tiered clinicopathological classification of pituitary tumors. First, we validate that pituitary tumor grades predict the evolutionary risk of the tumor, with a significant higher risk of progression/recurrence in invasive and/or proliferative tumors (mean follow-up: 47 ± 30 months, median: 38 months). Moreover, our study provides evidence that patients with proliferative tumors have a higher risk to be retreated after primary surgery and point toward the fact that radiotherapy can successfully control tumor growth in case of progression or recurrence. Our findings advocate for a personalized therapeutic approach in clinically aggressive pituitary tumors.</jats:p>\n               </jats:sec>","journal":"European Journal of Endocrinology","year":2022,"id":19840,"datarank":1.4085555002833317,"base_score":3.6375861597263857,"endowment":3.6375861597263857,"self_citation_contribution":0.5456379239589579,"citation_network_contribution":0.8629175763243737,"self_endowment_contribution":0.5456379239589579,"citer_contribution":0.8629175763243737,"corpus_percentile":null,"corpus_rank":null,"citation_count":37,"citer_count":33,"citers_with_citation_signal":23,"citers_with_endowment":23,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":133125,"name":"Romain Appay","orcid":null,"position":1,"is_corresponding":false},{"id":133126,"name":"Noémie Resseguier","orcid":null,"position":2,"is_corresponding":false},{"id":133127,"name":"Thomas Graillon","orcid":null,"position":3,"is_corresponding":false},{"id":133128,"name":"Cécilia Piazzola","orcid":null,"position":4,"is_corresponding":false},{"id":133129,"name":"Cécilia Laure","orcid":null,"position":5,"is_corresponding":false},{"id":133130,"name":"Dominique Figarella-Branger","orcid":null,"position":6,"is_corresponding":false},{"id":133131,"name":"Jean Régis","orcid":null,"position":7,"is_corresponding":false},{"id":133132,"name":"Frédéric Castinetti","orcid":"0000-0002-1808-8800","position":8,"is_corresponding":false},{"id":133133,"name":"Thierry Brue","orcid":"0000-0001-8482-6691","position":9,"is_corresponding":false},{"id":133134,"name":"Henry Dufour","orcid":null,"position":10,"is_corresponding":false},{"id":133135,"name":"Thomas Cuny","orcid":"0000-0002-8440-0030","position":11,"is_corresponding":false},{"id":133124,"name":"Nicolas Sahakian","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"base_score":3.6375861597263857,"endowment":3.6375861597263857,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36315463","pmcid":null,"openalex_id":"https://openalex.org/W4307717059","authors":[],"funders":[],"total_grants":0,"fwci":4.3184,"citation_percentile":0.95616088,"influential_citations":4,"citation_trend":[{"year":2023,"count":12},{"year":2024,"count":9},{"year":2025,"count":11},{"year":2026,"count":4}],"oa_status":"bronze","license":"https://academic.oup.com/pages/standard-publication-reuse-rights","oa_locations":[{"url":"https://academic.oup.com/ejendo/article-pdf/187/6/893/55146669/eje-22-0812.pdf","host_type":"journal"},{"url":"https://amu.hal.science/hal-04035095/file/2022_EJE_SAHAKIANb.pdf","host_type":"GREEN"},{"url":"https://academic.oup.com/ejendo/article-pdf/187/6/893/55146669/eje-22-0812.pdf","host_type":"publisher"},{"url":"https://eje.bioscientifica.com/view/journals/eje/187/6/EJE-22-0812.xml","host_type":"publisher"},{"url":"https://eje.bioscientifica.com/downloadpdf/journals/eje/187/6/EJE-22-0812.xml","host_type":"publisher"},{"url":"https://doi.org/10.1530/eje-22-0812","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36315463","host_type":"repository"},{"url":"https://amu.hal.science/hal-04035095","host_type":"repository"}],"fields_of_study":["Pituitary Gland Disorders and Treatments","Glioma Diagnosis and Treatment","Meningioma and schwannoma management","Medicine","Humans","Pituitary Neoplasms","Retrospective Studies","Prognosis","Proportional Hazards Models","Cohort Studies","Neoplasm Recurrence, Local","Neoplasm Grading"],"mesh_terms":["Humans","Neoplasm Recurrence, Local","Pituitary Neoplasms","Prognosis","Retrospective Studies","Cohort Studies","Proportional Hazards Models","Neoplasm Grading"],"keywords":["Medicine","Grading (engineering)","Internal medicine","Proportional hazards model","Oncology","Radiation therapy","Cohort","Multivariate analysis","Tumor progression","Adjuvant therapy","Progression-free survival","Gastroenterology","Overall survival","Cancer","Biology"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-06-04T05:58:23.416576Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}