Treatment selection towards active surveillance over definitive treatment for pituitary adenomas is influenced by sociodemographic factors - PubMed (original) (raw)

Treatment selection towards active surveillance over definitive treatment for pituitary adenomas is influenced by sociodemographic factors

Brandon M Lehrich et al. Clin Neurol Neurosurg. 2022 Nov.

Abstract

Background: Clinical and sociodemographic predictors of pituitary adenoma (PA) patients undergoing active surveillance (AS) versus definitive treatment (DT) are poorly understood.

Objective: This population-based analysis aims to identify clinical and sociodemographic predictors of undergoing AS versus DT.

Methods: The National Cancer Database (NCDB) was utilized to query PA patients diagnosed from 2010 to 2015 undergoing AS or DT. Independent-samples t-test and chi-squared test were used to compare differences in patient baseline characteristics and a stepwise binary logistic regression was performed to elucidate factors implicated in undergoing AS.

Results: The cohort consisted of 30,233 PA patients, with 5147 (17.0%) patients undergoing AS. On multivariable logistic regression, patients aged ≥ 65 years (OR=1.65; p < 0.001), African American race (OR=1.12; p = 0.035), having government insurance (OR=1.45; p < 0.001) or those uninsured (OR=1.58; p < 0.001) were significantly more likely to undergo AS compared to DT, while patients with larger tumors (OR=0.90; p < 0.001), receiving treatment at academic facilities (OR=0.75; p < 0.001), and living in West regions of the United States (OR=0.59; p < 0.001) were significantly less likely to undergo AS compared to DT.

Conclusions: Significant sociodemographic disparities exist in patient selection for undergoing AS versus DT, which may modify patient clinical outcomes.

Keywords: Active surveillance; Conservative management; Pituitary adenoma; Surgery; Watchful waiting.

Copyright © 2022 Elsevier B.V. All rights reserved.

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Conflict of interest statement

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1.

Fig. 1.

Trends of Treatment Over Time between 2010 and 2015. The graph represents stable rates of Active Surveillance (AS) and Definitive Treatment (TX) over time (R2 =0.32; p = 0.24).

Fig. 2.

Fig. 2.

Kaplan-Meier curve of overall survival for all pituitary adenoma patients matched on age, C/D, and tumor size comparing active surveillance versus definitive treatment.

References

    1. Cohen DL, Bevan JS, Adams CB, The presentation and management of pituitary tumours in the elderly, Age Ageing 18 (1989) 247–252. -PubMed
    1. Ntali G, Wass JA, Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas, Pituitary 21 (2018) 111–118. -PubMed
    1. Goshtasbi K, Lehrich BM, Abouzari M, Abiri A, Birkenbeuel J, Lan MY, et al. , Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study, J. Neurosurg (2020) 1–9. -PMC -PubMed
    1. Agam MS, Zada G, Complications associated with transsphenoidal pituitary surgery: review of the literature, Neurosurgery 65 (2018) 69–73. -PubMed
    1. Karsy M, Bowers CA, Scoville J, Kundu B, Azab MA, Gee JM, et al. , Evaluation of complications and costs during overlapping transsphenoidal surgery in the treatment of pituitary adenoma, Neurosurgery 84 (2019) 1104–1111. -PubMed

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