Frontiers in Endocrinology (May 2024)

A clinicopathological study of non-functioning pituitary neuroendocrine tumours using the World Health Organization 2022 classification

  • Chariene Shao-Lin Woo,
  • Ronnie Siu-Lun Ho,
  • Grace Ho,
  • Hoi-To Lau,
  • Carol Ho-Yi Fong,
  • Johnny Yau-Cheung Chang,
  • Eunice Ka-Hong Leung,
  • Lawrence Chi-Kin Tang,
  • Ivan Kwok-Ming Ma,
  • Alan Chun-Hong Lee,
  • David Tak-Wai Lui,
  • Yu-Cho Woo,
  • Wing-Sun Chow,
  • Gilberto Ka-Kit Leung,
  • Kathryn Choon-Beng Tan,
  • Karen Siu-Ling Lam,
  • Chi-Ho Lee

DOI
https://doi.org/10.3389/fendo.2024.1368944
Journal volume & issue
Vol. 15

Abstract

Read online

BackgroundThe 2022 World Health Organization (WHO) classification of pituitary neuroendocrine tumour (PitNET) supersedes the previous one in 2017 and further consolidates the role of transcription factors (TF) in the diagnosis of PitNET. Here, we investigated the clinical utility of the 2022 WHO classification, as compared to that of 2017, in a cohort of patients with non-functioning PitNET (NF-PitNET).MethodsA total of 113 NF-PitNET patients who underwent resection between 2010 and 2021, and had follow-up at Queen Mary Hospital, Hong Kong, were recruited. Surgical specimens were re-stained for the three TF: steroidogenic factor (SF-1), T-box family member TBX19 (TPIT) and POU class 1 homeobox 1 (Pit-1). The associations of different NF-PitNET subtypes with tumour-related outcomes were evaluated by logistic and Cox regression analyses.ResultsBased on the 2022 WHO classification, the majority of NF-PitNET was SF-1-lineage tumours (58.4%), followed by TPIT-lineage tumours (18.6%), tumours with no distinct lineage (16.8%) and Pit-1-lineage tumours (6.2%). Despite fewer entities than the 2017 classification, significant differences in disease-free survival were present amongst these four subtypes (Log-rank test p=0.003), specifically between SF-1-lineage PitNET and PitNET without distinct lineage (Log-rank test p<0.001). In multivariable Cox regression analysis, the subtype of PitNET without distinct lineage (HR 3.02, 95% CI 1.28-7.16, p=0.012), together with tumour volume (HR 1.04, 95% CI 1.01-1.07, p=0.017), were independent predictors of a composite of residual or recurrent disease.ConclusionThe 2022 WHO classification of PitNET is a clinically useful TF and lineage-based system for subtyping NF-PitNET with different tumour behaviour and prognosis.

Keywords