Survival determinants of patients with uncertain behavior pituitary tumors: A Surveillance, Epidemiology, and End Results (SEER) database study

Introduction

The “borderline” pituitary tumor category between typical benign adenomas and pituitary carcinomas is a subject of ongoing controversy. Surveillance, Epidemiology, and End Results (SEER) database classifies uncertain behavior pituitary tumors (UPTs) under the “borderline” category including atypical adenomas with presumed propensity for aggressive behavior. Very little is known about UPT patient survival prognostic factors. We aimed to characterize survival risk factors of patients with UPT according to the SEER database.

Methods

SEER 17 database was queried for pituitary tumors and further separated by SEER classification of “Borderline” under the category “ICD-O-3 Hist/behav, malignant”. Patient demographics, tumor characteristic, extent of disease and treatment data were extracted and analyzed. A nomogram was built assessing survival.

Results

Three hundred and thirty-two patients diagnosed between 2004 and 2019 were included. The survival rates at 1, 5 and 10 years were 86.8 %, 78.6 % and 65.1 %, respectively. Female sex and age <65 years correlated with a better prognosis (HR 2.41, 95 % CI [1.57–3.68], p = 4.00E-05 and HR 5.47; 95 % CI [3.53–8.45], p = 3.00E-15). Patients undergoing surgery had a better prognosis than those pursuing non-surgical management (HR 0.43, 95 % CI [0.19–0.97], p = 0.02). A nomogram incorporating sex, age and surgical versus non-surgical treatment status was created. The nomogram demonstrated acceptable accuracy in estimating the survival probability at 1- and 2-years, with a C-index of 0.751 (95 % CI: 0.641–0.861).

Conclusion

Female sex, age <65 years and surgical resection are significant factors determining UPT patient survival based on SEER data. The proposed nomogram achieved good potential for predicting UPT patient survival.