Multicenter external validation of the Zurich Pituitary Score

• DOI: 10.1007/s00701-020-04286-w
• Publication Date: 2020-03-14T13:02:36Z
• Authors: Victor E. Staartjes; Carlo Serra; Matteo Zoli; Diego Mazzatenta; Fabio Pozzi; Davide Locatelli; Elena D’Avella; Domenico Solari; Luigi Maria Cavallo; Luca Regli
• Keywords: Adenoma; Adult; Male; Extent of resection; External validation; Gross total resection; Outcome prediction; Pituitary adenoma; Zurich Pituitary Score; Neoplasm, Residual; 610 Medicine & health; Neurosurgical Procedures; 10180 Clinic for Neurosurgery; 03 medical and health sciences; 0302 clinical medicine; Gross total resection; Extent of resection; Humans; Zurich Pituitary Score; Pituitary Neoplasms; Aged; Neoplasm Staging; Extent of resection; External validation; Gross total resection; Outcome prediction; Pituitary adenoma; Zurich Pituitary Score; Adenoma; Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Neoplasm Staging; Neoplasm, Residual; Neurosurgical Procedures; Pituitary Neoplasms; Treatment Outcome; Tumor Burden; Endoscopy; Outcome prediction; Middle Aged; Pituitary adenoma; 2746 Surgery; External validation; Tumor Burden; 3. Good health; 2728 Neurology (clinical); Treatment Outcome; Female

Recently, the Zurich Pituitary Score (ZPS) has been proposed as a new quantitative preoperative classification scheme for predicting gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) in endoscopic pituitary surgery. We evaluated the external validity of the ZPS.In three reference centers for pituitary surgery, the ZPS was applied and correlated to GTR, EOR, and RV. Furthermore, its inter-rater agreement was assessed.A total of 485 patients (53% male; age, 53.8 ± 15.7) were included. ZPS grades I, II, III, and IV were observed in 110 (23%), 270 (56%), 64 (13%), and 41 (8%) patients, respectively. GTR was achieved in 358 (74%) cases, with mean EOR of 87.6% ± 20.3% and RV of 1.42 ± 2.80 cm3. With increasing ZPS grade, strongly significant decreasing trends for GTR (I, 92%; II, 77%; III, 67%; IV, 15%; p < 0.001) and EOR (I, 93.8%; II, 89.9%; III, 88.1%; IV, 75.4%; p < 0.001) were found. Similarly, RV increased steadily ([cm3] I, 0.16; II, 0.61; III, 2.01; IV, 3.84; p < 0.001). We observed intraclass correlation coefficients of 0.837 (95% CI, 0.804-0.865) for intercarotid distance and 0.964 (95% CI, 0.956-0.970) for adenoma diameter, and Cohen's kappa of 0.972 (95% CI, 0.952-0.992) for the ZPS grades.Application of the ZPS in three external cohorts was successful. The ZPS generalized well in terms of GTR, EOR, and RV; demonstrated excellent inter-rater agreement; and can safely and effectively be applied as a quantitative classification of adenomas with relevance to surgical outcome.