Journal of neuro-oncology · 2026
Racial and ethnic differences in presentation and postoperative recovery after transsphenoidal surgery for cushing disease.
СтатьяНазвание и аннотация: Перевод в очереди
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Roach Caleigh S, Himic Vratko, Dahake Richa, Shah Khushi H, Lu Victor M, Kreatsoulas Daniel, Jahangiri Arman, Villabona Carmen V, Sargi Zoukaa B, Shah Ashish H, Benjamin Carolina G, Komotar Ricardo J, Ivan Michael E
Аннотация
PURPOSE: This study aimed to determine where along the surgical care pathway race- and ethnicity-associated differences emerge after primary transsphenoidal surgery (TSS) for Cushing's disease (CD).
METHODS: Single-center retrospective cohort of 104 adults undergoing primary TSS for pathologically confirmed CD (2013-2024): 44 White non-Hispanic (WnH), 44 Hispanic, and 16 Black. Preoperative phenotype, perioperative complications, biochemical remission, radiographic persistence, and reintervention were compared across groups using unweighted statistics (Kruskal-Wallis, chi-square or Fisher's exact tests). Sensitivity analysis used inverse probability of treatment weighting (IPTW) with a multinomial propensity model; Black subgroup comparisons were considered exploratory.
RESULTS: Hispanic patients lived closer to the center (p = 0.003) and presented with milder disease. Black patients were younger (p = 0.003), with higher BMI (p = 0.033) and near-uniformly solid tumors (94%; p = 0.040). Postoperative arginine vasopressin deficiency was less frequent in Hispanic than WnH patients (25% vs. 55%; p = 0.005). Durable remission rates were comparable (WnH 79%, Hispanic 81%, Black 88%), though Black patients had higher day-1 cortisol and delayed remission on IPTW sensitivity, higher radiographic persistence (38% vs. 21%), and higher crude reintervention (25% vs. 4.5%; p = 0.036). On exploratory IPTW analysis, Hispanic patients also showed shorter reintervention-free survival despite favorable baseline features (IPTW HR 4.20; p = 0.036), a signal not apparent in unadjusted analysis.
CONCLUSION: Race- and ethnicity-associated differences emerged mainly at baseline presentation and in postoperative trajectory, whereas durable biochemical remission converged across groups; Black subgroup analyses were limited by small sample size and residual imbalance after weighting. These hypothesis-generating findings support postoperative surveillance tailored to where differences emerge rather than to ultimate remission and require validation in larger multicenter cohorts.
METHODS: Single-center retrospective cohort of 104 adults undergoing primary TSS for pathologically confirmed CD (2013-2024): 44 White non-Hispanic (WnH), 44 Hispanic, and 16 Black. Preoperative phenotype, perioperative complications, biochemical remission, radiographic persistence, and reintervention were compared across groups using unweighted statistics (Kruskal-Wallis, chi-square or Fisher's exact tests). Sensitivity analysis used inverse probability of treatment weighting (IPTW) with a multinomial propensity model; Black subgroup comparisons were considered exploratory.
RESULTS: Hispanic patients lived closer to the center (p = 0.003) and presented with milder disease. Black patients were younger (p = 0.003), with higher BMI (p = 0.033) and near-uniformly solid tumors (94%; p = 0.040). Postoperative arginine vasopressin deficiency was less frequent in Hispanic than WnH patients (25% vs. 55%; p = 0.005). Durable remission rates were comparable (WnH 79%, Hispanic 81%, Black 88%), though Black patients had higher day-1 cortisol and delayed remission on IPTW sensitivity, higher radiographic persistence (38% vs. 21%), and higher crude reintervention (25% vs. 4.5%; p = 0.036). On exploratory IPTW analysis, Hispanic patients also showed shorter reintervention-free survival despite favorable baseline features (IPTW HR 4.20; p = 0.036), a signal not apparent in unadjusted analysis.
CONCLUSION: Race- and ethnicity-associated differences emerged mainly at baseline presentation and in postoperative trajectory, whereas durable biochemical remission converged across groups; Black subgroup analyses were limited by small sample size and residual imbalance after weighting. These hypothesis-generating findings support postoperative surveillance tailored to where differences emerge rather than to ultimate remission and require validation in larger multicenter cohorts.