Predicting tumor progression in non-functioning pituitary macroadenomas following transnasal transsphenoidal resection: insights from a single-center retrospective cohort study

Introduction: This retrospective, single-center study aimed to identify predictive factors for progression in postoperative residual findings of non-functioning pituitary macroadenomas (NFPMAs). The findings are intended to support individualized decisions regarding follow-up and adjuvant therapy. Methods: A retrospective analysis was conducted on 212 patients treated at a tertiary referral center between 2007 and 2023. Patients underwent MRI-guided, transnasal transsphenoidal surgery for histologically confirmed NFPMAs. Pre- and postoperative tumor volumes were assessed alongside demographic, clinical, and histopathological data. Tumor configuration was classified using Hardy and Knosp scales. Subgroups were defined based on postoperative imaging: stable residuals, progressive residuals, or recurrence after gross total resection (GTR). Statistical analyses included multivariate testing and ROC analysis to determine predictive cutoff values. Results: = 0.022; exploratory). Conclusion: for stability. These findings could inform tailored follow-up strategies. Prospective studies are warranted to validate these results and further explore the impact of surgical and tumor characteristics on long-term outcomes.