LONG-TERM MORTALITY AFTER TRANSSPHENOIDAL SURGERY AND ADJUNCTIVE THERAPY FOR ACROMEGALY

To analyze the long term outcome after multimodality therapy for acrom egaly, a retrospective review was performed on 162 patients who underw ent transsphenoidal surgery at Massachusetts General Hospital between 1978 and 1996. The surgical cure rate for microadenomas was 91%, that for macroadenomas was 48%, and it was 57% overall. The surgical cure r ate was significantly dependent on tumor size, but was not dependent o n age or sex. An improvement in the surgical cure rate was noted over the course of the review, from 45% before 1987 to 73% since 1991. Long term follow-up was obtained in 99% of U.S, residents (149 of 151), wi th a mean follow-up period of 7.8 yr. Adjuvant radiation and/or pharma cological therapy was given to 61 patients. Of the entire group, 83% ( 124 of 149) were in biochemical remission as determined by normalizati on of serum insulin-like growth factor I levels or by GH suppression a fter oral glucose tolerance testing at last contact or at death. The r ecurrence rate was 6% at 10 yr and 10% at 15 yr after surgery in those patients who initially met the criteria for surgical cure. The 10-yr survival rate was 88%, and there were 12 deaths at postoperative inter vals of 2-12 yr, with the most common cause of death being cardiovascu lar disease. A Cox proportional hazards model showed that patient-year s with persistent disease carried a 3.5-fold [95% confidence interval( CI), 1.0-12; P = 0.02] relative mortality risk compared to those patie nt-years in remission. A Poisson person-years regression analysis show ed no significant difference in survival between those 86 patients cur ed at operation and an age- and sex-matched sample from the U.S. popul ation [standardized mortality ratio (SMR), 0.84; 95% CI, 0.3-2.2; P = 0.35]. A similar analysis on the entire group of 149 patients showed n o significant difference in survival from that in a control sample (SM R, 1.16; 95% CI, 0.66-2.0; P = 0.3). Mortality risk for patient-years with persistent active disease after unsuccessful treatment us. that i n the U.S. population sample remained increased (SMR, 1.8; 95% CI, 0.9 -3.6; P = .05). This analysis suggests that the decreased survival pre viously reported to be associated with acromegaly can be normalized by successful surgical and adjunctive therapy.