Pituitary · 2025
Surgical management in very elderly patients with pituitary adenoma: a multivariable assessment of the surveillance, epidemiology, and end results database.
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Gould Jacob, Singh Arjit, Patel Saarang, Yaffe Noah, Li Guan, Blanpain Lou, Gendreau Julian L
Аннотация
BACKGROUND: The management of pituitary adenomas in very elderly patients (age ≥ 85 years) remains challenging due to age-related frailty and variability in treatment tolerance. This study aimed to identify clinical and sociodemographic factors associated with survival in patients age ≥ 85 years with pituitary adenoma and assess the plausibility of surgical resection.
METHODS: Patients aged 85 and up (very elderly cohort) were queried from the SEER database. Additionally, patients from the age range of 75-84 (elderly cohort) were queried for comparisons. Demographic variables, adenoma size, and treatment variables were assessed, and differences were identified using a Chi-squared tests for independence and two-sample t-tests. Differences in survival were assessed using multivariable Cox proportional hazards models stratified by age cohort. Kaplan-Meier plots were generated to assess survival differences among treatment groups in the very elderly cohort.
RESULTS: Across all cohorts, subtotal resection and female sex were independently associated with improved survival and age was associated with worse survival. For the very elderly cohort, adenoma size (HR = 1.004; p = 0.005) was associated with worse overall survival, while female sex (HR = 0.656; p < 0.001) and subtotal resection (HR = 0.557; p = 0.005) were associated with increased overall survival. Black race was associated with worse survival in the 75-84 elderly cohort only (HR = 1.479; p < 0.001).
CONCLUSION: In patients ≥ 85 years of age with pituitary adenoma, surgical resection appears to provide an overall benefit to survival and should be considered among other factors.
METHODS: Patients aged 85 and up (very elderly cohort) were queried from the SEER database. Additionally, patients from the age range of 75-84 (elderly cohort) were queried for comparisons. Demographic variables, adenoma size, and treatment variables were assessed, and differences were identified using a Chi-squared tests for independence and two-sample t-tests. Differences in survival were assessed using multivariable Cox proportional hazards models stratified by age cohort. Kaplan-Meier plots were generated to assess survival differences among treatment groups in the very elderly cohort.
RESULTS: Across all cohorts, subtotal resection and female sex were independently associated with improved survival and age was associated with worse survival. For the very elderly cohort, adenoma size (HR = 1.004; p = 0.005) was associated with worse overall survival, while female sex (HR = 0.656; p < 0.001) and subtotal resection (HR = 0.557; p = 0.005) were associated with increased overall survival. Black race was associated with worse survival in the 75-84 elderly cohort only (HR = 1.479; p < 0.001).
CONCLUSION: In patients ≥ 85 years of age with pituitary adenoma, surgical resection appears to provide an overall benefit to survival and should be considered among other factors.