类固醇生成因子1表达水平与垂体腺瘤患者激素水平的关系及其对术后复发预测价值的研究OA

Background Some pituitary adenomas(PA)are resistant to medical therapy,motivating investigation of pituitary‑related transcription factors as therapeutic targets.The prognostic value of steroidogenic factor‑1(SF‑1)level for postoperative outcomes in PA remains underexplored.Objective To analyze the relationship between SF‑1 and hormone levels and to evaluate their value in predicting postoperative recurrence for PA patients.Methods In this prospective study,104 patients diagnosed with PA at Tangshan People's Hospital between May 2022 and June 2023 who underwent gross total resection were enrolled.Relative SF‑1 mRNA expression level was measured in PA tissue and adjacent non‑tumorous tissue.Based on SF‑1 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 SF‑1 mRNA level as the dependent variable to evaluate hormonal influences on SF‑1mRNA expression.Patients were also classified by postoperative outcome into recurrence(n=40)and non‑recurrence(n=64)groups to assess the association between SF‑1 mRNA expression level and recurrence.Receiver operating characteristic(ROC)analysis,restricted cubic spline(RCS)modeling with threshold‑effect analysis,and Kaplan-Meier survival analysis were used to evaluate predictive performance and recurrence‑free survival.Results SF‑1 mRNA expression level 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 SF‑1 high‑expression group exhibited higher levels of growth hormone(GH),anterior gradient 2(AGR2),prolactin(PRL),thyroid‑stimulating hormone(TSH),and adrenocorticotropic hormone(ACTH)compared with the low‑expression group(P<0.05).Stratified regression identified GH,AGR2,PRL,TSH,and ACTH as positive predictors of SF‑1 mRNA expression level(P<0.05).Comparisons between recurrence and non‑recurrence groups demonstrated statistically significant differences in SF‑1 mRNA expression level,tumor stage,histological differentiation,GH,AGR2,PRL,TSH and ACTH(P<0.05).Multivariate Logistic regression indicated that SF‑1 mRNA expression level remained an independent predictor of postoperative recurrence after adjustment for covariates(P<0.05).The area under the curve(AUC)for SF‑1 mRNA expression level 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 0.87 for SF‑1 mRNA expression level,the OR for recurrence per unit increase in SF‑1 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 SF‑1 mRNA expression level.Kaplan-Meier analysis showed median recurrence‑free survival of 15 months(95%CI=11.16-18.43)in the SF‑1 mRNA high‑expression group versus 28 months(95%CI=23.54-31.54)in the low‑expression group;the difference was significant by log‑rank test(χ2=7.861,P<0.001).Conclusion SF‑1 mRNA is markedly upregulated in PA tissue and its high expression is independently associated with elevated GH,AGR2,PRL,TSH,and ACTH levels.SF‑1 mRNA expression level may serve as a potential biomarker to assess hormonal status and predict postoperative recurrence risk in PA patients.