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.
Keywords pituitary carcinoma - Affordable Care Act - SEER - outcomes - health care expansion
