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Characteristics and overall survival in pediatric versus adult pituitary adenoma: a National Cancer Database analysis

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Abstract

Objective

Pituitary adenomas in the pediatric population are extremely rare, resulting in limited information in the literature on these patients. In this study, data from the National Cancer Database (NCDB) to compare pituitary adenoma clinical presentations, treatment management patterns, and overall survival between pediatric and adult patients.

Methods

The NCDB was queried for all cases of histologically confirmed pituitary adenoma treated between 2004 and 2015. Patients were primarily stratified as either pediatric (< 18 years) or adult (≥ 18 years). Patient demographics/socioeconomics and resulting outcomes were then compared.

Results

1893 pediatric and 77,993 adult patients with pituitary adenomas were evaluated. Average tumor size for pediatric and adult patients was 13.6 ± 13.2 mm and 20.1 ± 13.1 mm, respectively (p < 0.001). Pediatric patients were more likely to undergo gross total resection, less likely to receive adjuvant radiation, more likely to receive medical therapy, more likely to undergo active surveillance, and exhibited improved 5-year and 10-year overall survival (OS) (all p < 0.001). Temporal analysis demonstrated a significant increase in endoscopic approach over time (from 48 to 65%) in the pediatric population (R2 = 0.722, p = 0.03). On univariate analysis in the pediatric population, African American race compared to Caucasians (HR: 5.85, 95% CI 1.79–19.2, p < 0.003), patients with government insurance compared to those with private insurance (HR: 5.07, 95% CI 1.31–19.6, p < 0.02) and uninsured patients compared to those with private insurance (HR: 14.4, 95% CI 2.41–86.5, p < 0.003) were associated with decreased OS. Lastly, patients who underwent GTR had improved OS compared to those who underwent subtotal resection (HR: 0.08, 95% CI 0.008–0.93, p < 0.04) in the pediatric population.

Conclusions

Compared to adults, children with pituitary adenomas more commonly underwent GTR, less frequently underwent adjuvant radiotherapy, more frequently underwent medical management and active surveillance, and had improved survival. Temporal analysis demonstrated increasing utilization of the endoscopic approach for surgical treatment of pediatric and adult pituitary adenoma patients.

Level of evidence

Level III.

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Funding

Research reported in this publication was in part supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number T32GM008208 to BML. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of California, 101 The City Drive South, Irvine, Orange, CA, 92868, USA

    Benjamin F. Bitner, Arash Abiri, Tyler M. Yasaka & Edward C. Kuan

  2. Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA

    Brandon M. Lehrich

  3. Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA

    Frank P. K. Hsu & Edward C. Kuan

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Bitner, B.F., Lehrich, B.M., Abiri, A. et al. Characteristics and overall survival in pediatric versus adult pituitary adenoma: a National Cancer Database analysis. Pituitary 24, 714–723 (2021). https://doi.org/10.1007/s11102-021-01146-3

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