====== Non-Functioning Pituitary Neuroendocrine Tumor Systematic Reviews ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1Re_a8-P-Jvyurk18fo0Tw56KKumws2UXgBKObdWK_SorC5UiJ/?limit=15&utm_campaign=pubmed-2&fc=20230630142728}}
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[[Surgical resection]] is the main [[Clinically Non-Functioning Pituitary Neuroendocrine Tumor Treatment]].
Fong et al. 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]].

An electronic literature search 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 the provision of Kaplan-Meier curves, were included. These were digitized to obtain IPD, which was pooled in one-stage and two-stage meta-analyses 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 techniques were also performed.

Altogether, 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).

This systematic review and patient-level meta-analysis robustly prognoses of surgically treated NFPA. They reinforce current guidelines stating that GTR should be the standard of surgical resection. Postoperative radiotherapy is of considerable benefit, especially for patients with STR. The surgical approach does not significantly affect long-term prognosis.

[[Registration]]: [[PROSPERO]] CRD42022374034
((Fong KY, Lim MJR, Fu S, Low CE, Chan YH, Deepak DS, Xu X, Thong M, Jain S, Teo K, Gardner PA, Snyderman CH, Nga VDW, Yeo TT. Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis. Pituitary. 2023 Jun 30. doi: 10.1007/s11102-023-01335-2. Epub ahead of print. PMID: 37389776.)).