Founding of a National Surgical Research Consortium for Pituitary Disorders: Description of Cushing’s Disease Cohort, Surgeon Characteristics, and Report of Outcomes

Background: United States neurosurgical societies and pituitary surgeons have long called for a multicenter research consortium to better understand surgical outcomes, improve patient care, disseminate best practices, and facilitate multicenter surgery research at scale for pituitary disorders. To address this need, we established a national pituitary surgical research platform (Registry for Adenomas of the PItuitary and related Disorders, RAPID). The initial focus of the collaboration was Cushing’s disease. The aims of this current study were to describe the current RAPID patient cohort, to explore surgical outcomes, and to lay the foundation for future studies that address the limitations of prior work.

Methods: Prospectively and retrospectively obtained data from participating United States academic pituitary centers sites were aggregated using a cloud-based registry and analyzed retrospectively. Standard preoperative variables and outcome measures such as length of stay, disposition location, and disease remission were determined.

Results: As of July 2023, a total of 528 patients with Cushing’s disease were treated by 26 neurosurgeons of varying levels of experience at nine academic pituitary centers from 2003 to 2023. No surgeon contributed more than 84/528 (15.9%) patients ([Fig. 1]). The mean patient age was 43.8 ± 13.9 years, and most patients were female (82.2%, 433/527). The mean tumor diameter was 0.8 ± 2.7 cm. Seventy-six percent (354/462) of patients had no prior treatment. The most common pathology was corticotroph tumor (72.2%, 381/528). The mean length of stay was 3.8 ± 2.5 days. The most common site of disposition was home (97.2%, 448/461). There were two (2/461, 0.4%) perioperative deaths. The median actuarial disease-free survival following index surgery for the entire cohort was 8.5 years ([Fig. 2]).

Conclusions: This report described a first-of-its-kind U.S. multicenter pituitary research collaboration. We developed a robust dataset and evaluated patient outcomes following Cushing’s surgery. It revealed novel insights into surgical outcomes not possible with prior single center studies, such as actuarial disease recurrence rates across a series of surgeons practicing in different environments. This collaboration will enable future studies that advance the standard of care for these patients.

Fig. 1

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Artikel online veröffentlicht:
05. Februar 2024