关键词: 垂体腺瘤, 类固醇生成因子 1, 激素, 预后, 术后预测

Abstract: Background　Some pituitary adenomas (PA) are resistant to medical therapy, motivating investigation of pituitaryrelated transcription factors as therapeutic targets. The prognostic value of steroidogenic factor1 (SF1) expression for postoperative outcomes in PA remains underexplored. Objective　To analyze the relationship between SF1 expression and hormone levels and to evaluate their value in predicting postoperative recurrence in PA patients. Methods　In this prospective study, 104 patients diagnosed with PA at Tangshan People's Hospital between May 2022 and March 2023 who underwent gross total resection were enrolled. Relative SF1 mRNA expression was measured in PA tissue and adjacent nontumorous tissue. Based on SF1 mRNA levels, patients were grouped into low expression (n=49) and high expression (n=55) cohorts. Baseline characteristics and hormone profiles were compared between groups. Stratified regression analyses were performed using hormone indices as independent variables and SF1 mRNA level as the dependent variable to evaluate hormonal influences on SF-1 expression. Patients were also classified by postoperative outcome into recurrence (n=40) and nonrecurrence (n=64) groups to assess the association between SF1 mRNA expression and recurrence. Receiver operating characteristic (ROC) analysis, restricted cubic spline (RCS) modeling with thresholdeffect analysis, and Kaplan-Meier survival analysis were used to evaluate predictive performance and recurrencefree survival. Results　SF1 mRNA expression was significantly higher in PA tissue (1.05±0.21) than in adjacent tissue (0.38±0.07) (t=30.867, P<0.05). The SF1 highexpression group exhibited higher levels of growth hormone (GH), anterior gradient 2 (AGR2), prolactin (PRL), thyroidstimulating hormone (TSH), and adrenocorticotropic hormone (ACTH) compared with the lowexpression group (P<0.05). Stratified regression identified GH, AGR2, PRL, TSH, and ACTH as positive predictors of SF1 mRNA expression (P<0.05). Comparisons between recurrence and nonrecurrence groups demonstrated statistically significant differences in SF1 mRNA expression, tumor stage, histological differentiation, GH, AGR2, PRL, and ACTH (P<0.05). Multivariate logistic regression indicated that SF1 mRNA expression remained an independent predictor of postoperative recurrence after adjustment for covariates (P<0.05). The area under the curve (AUC) for SF1 mRNA predicting postoperative recurrence was 0.705 (95%CI=0.604-0.806; P<0.005); the optimal cutoff was 0.87, yielding sensitivity 0.806 and specificity 0.634. RCS analysis identified an inflection point at SF1=0.87; the odds ratios (OR) for recurrence per unit increase in SF1 mRNA were 1.006 (95%CI=1.002-1.011, P=0.026) before the inflection and 1.007 (95%CI=1.005-1.009, P=0.017) after it, indicating a rising recurrence risk with increasing SF1 expression. Kaplan-Meier analysis showed median recurrencefree survival of 15 months (95%CI=11.16-18.43) in the SF1 highexpression group versus 28 months (95%CI=23.54-31.54) in the lowexpression group; the difference was significant by logrank test (χ2 =7.861, P<0.001). Conclusion　SF1 mRNA is markedly upregulated in PA tissue and its high expression is independently associated with elevated GH, AGR2, PRL, TSH, and ACTH levels. SF1 mRNA expression may serve as a potential biomarker to assess hormonal status and predict postoperative recurrence risk in PA patients; combined assessment with hormones such as GH and AGR2 may improve predictive accuracy.

Key words: Pituitary adenoma, Steroidogenic factor 1, Hormone, Prognosis, Postoperative prognosis