https://orcid.org/0000-0002-3628-7686
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Tobias Hallén, Daniel S Olsson, Casper Hammarstrand, Charlotte Örndal, Angelica Engvall, Oskar Ragnarsson, Thomas Skoglund, Gudmundur Johannsson, MCM7 as a marker of postsurgical progression in non-functioning pituitary adenomas, European Journal of Endocrinology, Volume 184, Issue 4, Apr 2021, Pages 521–531, https://doi.org/10.1530/EJE-20-1086
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Abstract
Current markers predicting tumour progression of pituitary adenomas after surgery are insufficient. Our objective was to investigate if minichromosome maintenance protein 7 (MCM7) expression predicts tumour progression in non-functioning pituitary adenomas (NFPAs).
In a cohort study of surgically treated NFPAs, two groups with distinctly different behaviour of a residual tumour were selected: one group requiring reintervention due to tumour progression (reintervention group, n = 57) and one with residual tumours without progression (radiologically stable group, n = 40). MCM7, Ki-67, oestrogen receptor-α expression, mitotic index and tumour subtype were assessed by immunohistochemistry, and their association with tumour progression requiring reintervention was analysed.
Median (IQR) MCM7 expression was 7.4% (2.4–15.2) in the reintervention group compared with 2.0% (0.6–5.3) in the radiologically stable group (P <0.0001). Cox regression analysis showed an association between high (>13%) MCM7 expression and reintervention (HR: 3.1; 95% CI:1.7–5.4; P = 0.00012). The probability for reintervention within 6 years for patients with high MCM7 was 93%. Ki-67 expression >3% (P = 0.00062), age ≤55 years (P = 0.00034) and mitotic index≥1 (P = 0.024) were also associated with reintervention. Using a receiver operating characteristics curve, a predictive model for reintervention with all the above predictors yielded an area under the curve of 82%. All eight patients with both high MCM7 and high Ki-67 needed reintervention.
This cohort study shows that expression of MCM7 is a predictor for clinically significant postoperative tumour progression. Together with age, Ki-67 and mitotic index, MCM7 might be of added value as a predictive marker when managing patients with NFPA after surgery.
