BACKGROUND The prompt control of acromegaly is a primary treatment aim, for reducing related disease morbidity and mortality. First-generation somatostatin receptor ligands (fg-SRL) are the cornerstone of medical therapies. A non-negligible number of patients do not respond to this treatment. Several predictors of fg-SRL response were identified, but a -comprehensive prognostic model is lacking. We aimed at designing a prognostic model based on clinical, biochemical parameters, pathological features, including data on immune tumor microenvironment.Patients and methods: A retrospective, monocenter cohort study was performed on 67 medical naïve acromegaly patients. Fifteen clinical, pathological, and radiological features were collected and analyzed as independent risk factors of fg-SRLs response, though an univariable and multivariable logistic regression analyses. A stepwise selection method was applied to identify the final regression model. A nomogram was then obtained. RESULTS Thirty-seven patients were fg-SRLs responders. An increased risk to poor response to fg-SRLs were observed in somatotropinomas with absent/cytoplasmatic SSTR2 expression (OR: 5.493 95%IC: 1.19-25.16, p=0.028), with low CD68+/CD8+ ratio (OR: 1.162, 95%IC: 1.01-1.33, p=0.032). Radical surgical resection was associated to a low risk of poor fg-SRLs response (OR: 0.106, 95%IC:0.025-0.447 p=0.002). The nomogram obtained from the stepwise regression model was based on CD68+/CD8+ ratio, SSTR2 score and the persistence of post-surgery residual tumor and was able to predict the response to fg-SRLs with good accuracy (AUC:0.85). CONCLUSION Although our predictive model should be validated in prospective studies, our data suggest that this nomogram may represent an easy-to-use tool, for early predicting the fg-SRLs outcome.

中文翻译：

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多生物标志物 acro-TIME 评分预测 fg-SRL 反应：回顾性肢端肥大症队列的初步结果。

背景技术肢端肥大症的迅速控制是降低相关疾病发病率和死亡率的主要治疗目标。第一代生长抑素受体配体（fg-SRL）是医学疗法的基石。不可忽视数量的患者对这种治疗没有反应。确定了 fg-SRL 反应的几个预测因素，但缺乏综合的预后模型。我们的目的是根据临床、生化参数、病理特征（包括免疫肿瘤微环境数据）设计一个预后模型。 患者和方法：对 67 名初次接受医学治疗的肢端肥大症患者进行了一项回顾性、单中心队列研究。通过单变量和多变量逻辑回归分析，收集并分析了 15 种临床、病理和放射学特征，作为 fg-SRL 反应的独立危险因素。应用逐步选择方法来确定最终的回归模型。然后获得列线图。结果 37 名患者对 fg-SRLs 有反应。在缺乏/细胞质 SSTR2 表达的生长激素瘤中观察到对 fg-SRL 反应不良的风险增加（OR：5.493 95％IC：1.19-25.16，p = 0.028），CD68 + / CD8 + 比率低（OR：1.162，95％） IC：1.01-1.33，p=0.032）。根治性手术切除与 fg-SRL 反应不良的低风险相关（OR：0.106，95%IC：0.025-0.447 p=0.002）。从逐步回归模型获得的列线图基于 CD68+/CD8+ 比率、SSTR2 评分和术后残留肿瘤的持续性，并且能够高精度预测对 fg-SRL 的反应（AUC：0.85）。结论 虽然我们的预测模型应该在前瞻性研究中得到验证，但我们的数据表明，该列线图可能代表一种易于使用的工具，用于早期预测 fg-SRLs 结果。