Evidence map›Paper›PMID 37389776›Full record

SynthesisPituitary2023

Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis.

Khi Yung Fong, Mervyn Jun Rui Lim, Shuning Fu, Chen Ee Low, Yiong Huak Chan, Doddabele Srinivasa Deepak, Xinni Xu, Mark Thong, Swati Jain, Kejia Teo and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Pituitary, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Article
  2. Article
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  8. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Khi Yung Fong *Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Mervyn Jun Rui Lim *Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore. mervynlim@u.nus.edu.ORCID http://orcid.org/0000-0002-6866-9531
Shuning FuYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Chen Ee LowYong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Yiong Huak ChanBiostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Doddabele Srinivasa DeepakDivision of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore.
Xinni XuDivision of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
Mark ThongDivision of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore, Singapore.
Swati JainDivision of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
Kejia TeoDivision of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
Paul A GardnerCenter for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Carl H SnydermanDepartment of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Vincent Diong Weng NgaDivision of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
Tseng Tsai YeoDivision of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSurgical resection is the main treatment for symptomatic nonfunctioning pituitary adenomas (NFPA). We aimed to analyze the impact of surgical approach, completeness of resection, and postoperative radiotherapy on long-term progression-free survival (PFS) of NFPA, using individual patient data (IPD) meta-analysis.

methodsAn electronic literature searched was conducted on PubMed, EMBASE, and Web of Science from database inception to 6 November 2022. Studies describing the natural history of surgically resected NFPA, with provision of Kaplan-Meier curves, were included. These were digitized to obtain IPD, which was pooled in one-stage and two-stage meta-analysis to determine hazard ratios (HRs) and 95%CIs of gross total resection (GTR) versus subtotal resection (STR), and postoperative radiotherapy versus none. An indirect analysis of single-arm data between endoscopic endonasal (EES) and microscopic transsphenoidal (MTS) surgical technique was also performed.

resultsAltogether, eleven studies (3941 patients) were retrieved. PFS was significantly lower in STR than GTR (shared-frailty HR 0.32, 95%CI 0.27-0.39, p < 0.001). Postoperative radiotherapy significantly improved PFS compared to no radiotherapy (shared-frailty HR 0.20, 95%CI 0.15-0.26, p < 0.001), including in the subgroup of patients with STR (shared-frailty HR 0.12, 95%CI 0.08-0.18, p < 0.001). Similar PFS was observed between EES and MTS (indirect HR 1.09, 95%CI 0.92-1.30, p = 0.301).

conclusionsThis systematic review and patient-level meta-analysis provides a robust prognostication of surgically treated NFPA. We reinforce current guidelines stating that GTR should be the standard of surgical resection. Postoperative radiotherapy is of considerable benefit, especially for patients with STR. Surgical approach does not significantly affect long-term prognosis. REGISTRATION: PROSPERO CRD42022374034.

Indexed as

FrailtyPituitary NeoplasmsEndoscopyHumansPrognosisProgression-Free SurvivalRetrospective StudiesTreatment OutcomeMeta-analysisNeurosurgeryPituitary adenomaPituitary neoplasmsRadiotherapy

Identifiers

PMID37389776

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.