PANOMEN-3 grading score is reliable in predicting a pituitary adenoma behavior and prognosis: a single center cohort validation study

Background: Pituitary adenomas comprise a heterogeneous group of diseases, with highly variable clinical manifestations, therapies and prognosis. A validated unified scoring system to guide prognosis and therapy early on is still missing for these patients.
Methods: We prospectively assessed a retrospective large single center cohort of patients with pituitary adenomas followed at our center over the last 24 years using a newly developed Pituitary Society grading system, PANOMEN-3.
Results: In our cohort, with a long follow-up (median>8 yrs), a high initial grade predicted a worse long-term outcome despite multimodal treatments (grade 3, remission OR 0.5, 95%CI [0.24; 0.98], p=0.047). Moreover, grade could predict tumor behaviour following surgery: a higher grade at baseline predicted relapse in cured cases (p=0.014) and a higher postoperative grade predicted the need for additional treatments in case of persisting disease (p=0.04). Interestingly, a score downgrade following failed surgery also prevented further long-term interventions (p=0.01). Moreover, a score downgrade early on for patients treated with primary medical treatment predicted lack of second-tier additional interventions and medically-induced remission.
Conclusion: Our data suggest for the first time that PANOMEN-3 grade system could be useful in everyday clinical practice, aiding physicians in both improving follow-up strategies of cured patients and in the management of persisting disease for all pituitary adenomas. Further multicenter validation studies with prospective design are needed to corroborate our findings, as well as studies evaluating other important patient outcomes such as comorbidities, quality of life and survival.