Clinical features and risk factors of invasiveness in non-functioning pituitary adenomas

TANG Fei; DING Yu; KANG Tianfeng; ZHANG Cheng; MAIMAITIYIMING Tuoheti; WU Yonggang

doi:10.11850/j.issn.1009-122X.2025.12.004

Abstract：Objective To analyze the clinical features and risk factors of invasiveness in non-functioning pituitary adenomas(NFPA).Methods Clinical data of 111 patients with NFPA were analyzed retrospectively.According to pituitary hormone testing,imaging examination,and postoperative pathological results,patients were divided into an invasive group(n=47)and a non-invasive group(n=64).The clinical data as demographic indicators,endocrine indicators,features of the tumor,and surgery-related indicators were collected.Univariate analysis was used to identify clinical features of invasiveness of NFPA,and multivariate analysis was employed to determine the influencing factors.Receiver operating characteristic(ROC)curves were plotted to analyze the influencing factors and their predictive efficacy for invasiveness.Cox regression analysis was utilized to identify factors influencing recurrence.Results Among the 111 NFPA patients,47(42.34%)were classified into the invasive group,and the remaining 64(57.66%)into the non-invasive group.The invasive group exhibited larger maximum tumor diameters,higher proportions of unilateral/bilateral hemianopsia,irregular tumor shapes,optic nerve compression,and cavernous sinus invasion,but a lower proportion of tumor apoplexy compared to the non-invasive group(all P<0.05).The invasive group also had higher proportions of near-total/subtotal tumor resection and postoperative complications than the non-invasive group(both P<0.05).Multivariate logistic regression analysis revealed that total tumor resection and cavernous sinus invasion were influencing factors for invasiveness in NFPA patients,with total tumor resection serving as a protective factor(P<0.05).ROC analysis showed that the area under the curve(AUC)values for predicting NFPA invasiveness were 0.894 for the extent of tumor resection and 0.911 for cavernous sinus invasion;the combined assessment yielded the highest AUC value(0.969),significantly greater than those for individual predictions(Z=2.944,3.041,P<0.05).The recurrence rate was higher in the invasive group than in the non-invasive group(P<0.05).Multivariate Cox regression analysis indicated that cavernous sinus invasion and near-total/subtotal resection were risk factors for recurrence(P<0.05).Conclusions Cavernous sinus invasion is a risk factor for invasiveness in NFPA,while achieving total tumor resection is an important protective factor.The combination of these two indicators demonstrates good predictive value for invasiveness.Invasive NFPA has a higher recurrence rate,with cavernous sinus invasion and near-total/subtotal resection being risk factors for recurrence.Preoperative imaging assessment of cavernous sinus invasion holds core guiding value for predicting NFPA invasiveness and formulating surgical strategies.