Yuhui Chen

Purpose Pituitary adenomas (PAs) are common intracranial tumours with heterogeneous behaviour. Accurate risk stratification is critical for predicting recurrence/progression and for guiding management. The pituitary adenoma nomenclature 3 (PANOMEN 3) classification, introduced in 2024, integrates clinical, radiological, and pathological factors; however, its prognostic utility and histopathological criteria remain uncertain. Methods This multicentre retrospective cohort study included 804 patients with PAs surgically treated between January 2010 and December 2023. Patients were classified using the original PANOMEN 3 system and a modified system incorporating silent corticotroph adenomas (SCAs) as high-risk subtypes, revised proliferative activity criteria (Ki-67 ≥ 3%, mitotic index > 2/10 high-power fields, or p53 positivity), and Trouillas clinicopathological grading. Recurrence-free survival was analysed using Kaplan–Meier and Cox regression models. Predictive performance was assessed using receiver operating characteristic curves. Health-related quality of life (HRQoL) was measured using the EuroQol 5 Dimensions-3 Levels (EQ-5D-3 L) and EuroQol Visual Analogue Scale (EQ-VAS) preoperatively and six months postoperatively. Results Over a median follow-up of 5.0 years, 169 patients (21.0%) experienced recurrence/progression. The original PANOMEN 3 classification showed moderate predictive accuracy. The modified classification markedly improved predictive performance to match Trouillas’ grading. Higher PANOMEN 3 grade was associated with poorer HRQoL outcomes. Conclusion The PANOMEN 3 classification provides clinically relevant prognostic value for recurrence/progression and postoperative HRQoL in PAs. The inclusion of SCAs and refined proliferative criteria enhanced predictive accuracy and demonstrated its potential as a comprehensive risk stratification tool. Prospective studies, including non-surgical cohorts, are warranted to confirm its generalisability.

Objective: This study aims to develop a predictive model for cavernous sinus dural invasion in pituitary adenomas by retrospectively analyzing clinical and imaging data. It explores the associations between clinical and radiomics features and cavernous sinus dural invasion. Methods: Clinical data and coronal T2-weighted MRI images were collected from patients diagnosed with pituitary adenomas at our institution between December 2012 and December 2022. Tumor regions of interest (ROIs) were segmented using 3D Slicer, and radiomics features were extracted. Statistically significant radiomics features were identified using Lasso regression and univariate analysis. Clinical features were screened using univariate and multivariate logistic regression analyses. These selected features were incorporated into ten machine learning algorithms to construct three predictive models: a clinical feature model, a radiomics feature model, and a combined clinical and radiomics feature model. Model performance was evaluated to determine the best-performing model, which was further interpreted. Results: A total of 252 patients with histopathologically confirmed pituitary adenomas were included. The analysis identified Knosp grade, tumor left-right diameter, pedunculated satellite tumor, and clival invasion as significant clinical predictors, along with radiomics features including original.4, original.10, log-sigma-5-0-mm-3D.29, log-sigma-5-0-mm-3D.91, wavelet-LLH.37, wavelet-LHL.37, and wavelet-HLL.8. The combined clinical and radiomics model outperformed models based solely on clinical or radiomics features. Among the ten machine learning algorithms, the LightGBM model demonstrated the best predictive performance, achieving an area under the curve (AUC) of 0.86 and an accuracy (ACC) of 0.76. Conclusions: A machine learning model integrating clinical and radiomics features can effectively predict cavernous sinus dural invasion in pituitary adenomas preoperatively, providing a reliable basis for diagnosing tumor invasiveness and developing surgical plans. The LightGBM algorithm exhibited the highest predictive efficacy. Furthermore, the pedunculated satellite tumor feature emerged as a novel imaging marker for cavernous sinus dural invasion, offering new insights into the study of invasive pituitary adenomas.

Introduction: Pediatric traumatic brain injury (PTBI) is linked to significant disability and mortality. This study aimed to identify risk factors for unfavorable outcomes in patients with PTBI and develop a predictive risk model.Methods: A retrospective analysis was conducted on patients with PTBI treated at the 900th Hospital from September 2021 to June 2023. Univariate and multivariate regression analyses identified risk factors for adverse outcomes and facilitated the creation of a nomogram. The model's predictive accuracy was assessed using Receiver Operating Characteristic (ROC) curves, calibration curves, and Decision Curve Analysis (DCA). External validation was performed with patients with PTBI from Fujian Children's Hospital.Results: Key findings indicated that a Glasgow Coma Scale (GCS) score ≤8, subdural hematoma, subarachnoid hemorrhage, and coagulopathy were independent risk factors. The nomogram achieved an area under the ROC curve of 0.947 in the development cohort and 0.834 in the external validation cohort, demonstrating a good fit. DCA results confirmed that the nomogram enhanced the prediction of unfavorable outcomes.Conclusions: This risk prediction model offers high accuracy for early identification of adverse outcomes, enabling timely interventions to improve the quality of life for patients with PTBI.

Background: Traumatic brain injury (TBI) is one of the diseases with high disability and mortality worldwide. Recent studies have shown that TBI-related factors may change the complex balance between bleeding and thrombosis, leading to coagulation disorders. The aim of this retrospective study was to investigate the prediction of coagulopathy and subdural hematoma thickness at admission using the Glasgow Outcome Scale (GOS) in patients with severe TBI at 6 months after discharge. Methods: In this retrospective cohort study, a total of 1006 patients with severe TBI in large medical centers in three different provinces of China from June 2015 to June 2021 were enrolled after the exclusion criteria, and 800 patients who met the enrollment criteria were included. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values of platelet (PLT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and subdural hematoma (SDH) thickness. The ROC curve, nomogram, calibration curve, and the decision curve were used to evaluate the predictive effect of the coagulopathy and Coagulopathy-SDH(X1) models on the prognoses of patients with severe TBI, and the importance of predictive indicators was ranked by machine learning. Results: Among the patients with severe TBI on admission, 576/800 (72%) had coagulopathy, 494/800 (61%) had SDH thickness ≥14.05 mm, and 385/800 (48%) had coagulopathy combined with SDH thickness ≥14.05 mm. Multivariate logistic regression analyses showed that age, pupil, brain herniation, WBC, CRP, SDH, coagulopathy, and X1 were independent prognostic factors for GOS after severe TBI. Compared with other single indicators, X1 as a predictor of the prognosis of severe TBI was more accurate. The GOS of patients with coagulopathy and thick SDH (X1, 1 point) at 6 months after discharge was significantly worse than that of patients with coagulopathy and thin SDH (X1, 2 points), patients without coagulopathy and thick SDH (X1, 3 point), and patients without coagulopathy and thin SDH (X1, 4 points). In the training group, the C-index based on the coagulopathy nomogram was 0.900. The C-index of the X1-based nomogram was 0.912. In the validation group, the C-index based on the coagulopathy nomogram was 0.858. The C-index of the X1-based nomogram was 0.877. Decision curve analysis also confirmed that the X1-based model had a higher clinical net benefit of GOS at 6 months after discharge than the coagulopathy-based model in most cases, both in the training and validation groups. In addition, compared with the calibration curve based on the coagulopathy model, the prediction of the X1 model-based calibration curve for the probability of GOS at 6 months after discharge showed better agreement with actual observations. Machine learning compared the importance of each independent influencing factor in the evaluation of GOS prediction after TBI, with results showing that the importance of X1 was better than that of coagulopathy alone. Conclusion: Coagulopathy combined with SDH thickness could be used as a new, accurate, and objective clinical predictor, and X1, based on combining coagulopathy with SDH thickness could be used to improve the accuracy of GOS prediction in patients with TBI, 6 months after discharge.

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