Risk factors for immediate remission after operation in patients with Cushing's disease

Abstract

Objective To explore the preoperative factors affecting the immediate remission of Cushing's disease after transsphenoidal surgery. Methods A total of 420 patients with Cushing's disease (led by Dr. Feng Ming) in the Department of Neurosurgery of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to August 2020 were included. Univariate and multivariate Logistic regression analyses were performed to find risk factors for immediate remission after operation of Cushing's disease, and receiver operating characteristic curve (ROC) was used to predict the cut⁃off value of immediate remission after operation. Results Among 420 patients with Cushing's disease, 318 patients had immediate remission after operation, and the immediate remission rate was 75.71%. Logistic regression analysis showed that non⁃primary surgery (OR = 3.904, 95%CI: 2.199-6.930; P = 0.000) and high adrenocorticotropic hormone level (OR = 0.995, 95%CI: 0.991-0.999; P = 0.027) were risk factors for immediate remission after opration in patients with Cushing's disease. ROC showed the area under the curve (AUC), sensitivity and specificity of 85.45 pg/ml adrenocorticotropic hormone level (best threshold) for predicting immediate remission after operation were 0.586 (95%CI: 0.524-0.648, P = 0.009), 0.510 and 0.640. Conclusions Preoperative adrenocorticotropic hormone and the first operation are important factors affecting the immediate remission of patients with Cushing's disease after transsphenoidal operation. Endocrinologists and neurosurgeons should pay attention to the factors affecting the prognosis of patients during the preoperative evaluation of patients with Cushing's disease and make good communication between doctors and patients.

Keywords

• cushing syndrome
• pituitary neoplasms
• adrenocorticotropic hormone
• logistic models