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PNA Medical Corner: Age and progression-free survival with nonfunctioning pituitary adenomas

Dr. John Atkinson

Dr. Jamie Van Gompel

Dr. Maria Peris Celda

This month the PNA Medical Corner focuses on a study coauthored by three members of the PNA: Drs. John Atkinson, Jamie Van Gompel and Maria Peris Celda. They conclude that older patients with nonfunctioning pituitary tumors had better progression-free survival rates, even when they underwent aggressive surgery.

https://pubmed.ncbi.nlm.nih.gov/38669710/

Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas

Yuki Shinya ^1 2, John L D Atkinson ¹, Dana Erickson ³, Irina Bancos ³, Carlos D Pinheiro Neto ⁴, Caroline J Davidge-Pitts ³, Maria Peris Celda ¹, Justine S Herndon ³, Sukwoo Hong ^1 2, Jamie J Van Gompel ¹

Abstract

Objective: Nonfunctioning pituitary adenomas (NFPAs) present at a wide range of ages; it is possible that variable

outcomes are based on patient age at presentation. This study aimed to explore long-term outcomes of patients with NFPAs following endonasal transsphenoidal surgery (ETS), considering age stratification.

Methods: This retrospective study included 228 patients with NFPAs who underwent ETS, with a median follow-up period of 63 months. The outcomes included progression-free survival (PFS) rates and neurological and endocrinological outcomes. Age-stratified Kaplan-Meier and Cox proportional hazards analyses were performed. Patients were classified into four age groups: ≤ 49, 50-59, 60-69, and ≥ 70 years.

Results: Age-stratified analysis showed a significant correlation between age and PFS in NFPAs (5-year PFS rates: 63.0% in those ≤ 49 years, 76.7% in those 50-59 years, 85.0% in those 60-69 years, and 88.1% in those ≥ 70 years; p = 0.001, log-rank test). Bivariate (HR 1.03, 95% CI 1.01-1.05; p = 0.001) and multivariable (HR 1.03, 95% CI 1.02-1.05; p = 0.001) analyses demonstrated that older age was significantly associated with longer PFS. Multivariable analysis also demonstrated that smaller maximum tumor diameter (HR 0.77, 95% CI 0.60-0.99; p = 0.036) and gross-total resection (HR 8.55, 95% CI 3.90-18.75; p = 0.001) were significantly associated with longer PFS. Multivariable logistic regression analysis demonstrated that only younger age was associated with postoperative improvement of male hypogonadism (HR 0.91, 95% CI 0.84-0.99; p = 0.019). Other postoperative neurological and endocrinological outcomes were not significantly associated with age.

Conclusions: Older patients with NFPAs treated with ETS demonstrated a longer PFS. Of endocrinological outcomes studied, only male hypogonadism improvement was associated with younger patient age.

Keywords: age-dependent outcome; endonasal transsphenoidal surgery; nonfunctioning pituitary adenomas; pituitary surgery

The FDA has approved NGENLA (somatrogon-ghla)

The FDA has approved NGENLA (somatrogon-ghla), a once-weekly, human growth hormone analog indicated for treatment of pediatric patients aged three years and older who have growth failure due to an inadequate secretion of endogenous growth hormone.

See the Press Release here>

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