J Neurol Surg B Skull Base 2022; 83(03): 305-311
DOI: 10.1055/s-0040-1722747
Original Article

Pituitary Carcinoma Diagnosis and Survival Improvement, with Affordable Care Act Correlation: A SEER Database Study

1   Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts, United States
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2   Departments of Otolaryngology, Neurological Surgery, and Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, United States
3   Division of Biomedical & Health Technology Development & Transfer Domain, Boston University Institute for Health System Innovation & Policy, Boston, Massachusetts, United States
› Author Affiliations

Abstract

Introduction Pituitary carcinomas are challenging tumors to diagnose and treat due to their rarity and limited data surrounding their etiology. Traditionally, these patients have exhibited poor survival. Over the last several decades, our understanding of pituitary carcinomas has dramatically increased, and there have been recent initiatives to improve patient access to health care, including the Affordable Care Act (ACA). This study investigates whether there were any changes in incidence and treatment outcomes of pituitary carcinoma that correlated with these advances.

Methods A retrospective case review was conducted utilizing the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. Those with primary site pituitary tumors with noncontiguous metastases were identified from 1975 to 2016. Demographic data, overall, and cause-specific outcomes were obtained. The data were analyzed using SPSS to generate 5-year Kaplan–Meier curves.

Results The incidence of pituitary carcinoma pre- and post-ACA was 0.31 and 2.14 diagnoses/year, respectively. This represents a significant increase (Chi-square, p < 0.00002). In addition, 1-, 2-, and 5-year overall survival of these patients was determined to be 88.2, 74.0, and 66.6% which was significantly improved compared with prior studies. Cause-specific survival of these patients follow similar trends exhibiting 94.1, 79.0, 71.1% after 1, 2, and 5 years, respectively.

Conclusion The survival for pituitary carcinoma has improved significantly which signals a change in how practitioners should counsel their patients. There is a significant surge in the number of cases in the post-ACA timeline, which suggests that improving patient access has played a part in wider recognition and treatment initiation for this disease.

Authors' Contributions

N.J.W. was involved with data curation, methodology, writing the original draft, and formal analysis. A.K.D. contributed to the conceptualization, methodology, funding acquisition, supervision, writing the review, and editing of the manuscript.




Publication History

Received: 12 June 2020

Accepted: 01 November 2020

Article published online:
04 February 2021

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