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Multicenter external validation of the Zurich Pituitary Score

  • Original Article - Pituitaries
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank Mr. Nicola Podda for his original artwork (Figure 1).

Author information

Author notes

  1. Victor E. Staartjes and Carlo Serra contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Victor E. Staartjes, Carlo Serra & Luca Regli

  2. Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, Division of Neurosurgery, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy

    Matteo Zoli & Diego Mazzatenta

  3. Division of Neurosurgery, Ospedale di Circolo ASST Sette Laghi, University of Insubria, Varese, Italy

    Fabio Pozzi & Davide Locatelli

  4. Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Elena D’Avella, Domenico Solari & Luigi Maria Cavallo

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  1. Victor E. Staartjes
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Correspondence to Victor E. Staartjes.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Cantonal Ethics Committee Zürich, KEK St-V-Nr 2015-0142) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary methods 1

R Code for the statistical analysis and rendering of the figure. The code was executed in R Version 3.5.2 (The R Foundation for Statistical Computing, Vienna, Austria) on a machine running Windows 10 (Microsoft Corp., Redmond, WA, USA). (R 10 kb)

Supplementary Figure 1

Pooled gross total resection (GTR) rates among the Knosp grades. (JPEG 3651 kb)

Supplementary Table 1

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Staartjes, V.E., Serra, C., Zoli, M. et al. Multicenter external validation of the Zurich Pituitary Score. Acta Neurochir 162, 1287–1295 (2020). https://doi.org/10.1007/s00701-020-04286-w

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