A Population-Level Analysis of Pituitary Carcinoma from the National Cancer Database
28 June 2018
04 February 2019
15 March 2019 (online)
Objectives Pituitary carcinoma is a rare entity with fewer than 200 total cases reported in the English literature. Analysis of the population-level data from the National Cancer Database (NCDB) affords the opportunity to study this poorly understood tumor type.
Methods The NCDB was queried for site, histology, and metastasis codes corresponding to pituitary carcinoma. Statistical analyses were performed to determine factors associated with overall survival (OS).
Results A total of 92 patients with pituitary carcinoma met inclusion criteria. The 1 and 5 years of OS for all patients was 93.3% (95% confidence interval [CI]: 88.2–98.6%) and 80.0% (95% CI: 71.6–89.4%), respectively. Patients with invasive primary tumor behavior had 1 and 5 years of OS of 69.2% (95% CI: 48.2–99.5%) and 52.7% (95% CI: 31.2–89.2%), respectively. Multivariate analysis demonstrated that compared with benign primary behavior, invasive behavior had increased all-cause mortality (hazard ratio [HR], 1,296, 95% CI: 15.1– > 2,000). Surgery without adjuvant radiation or chemotherapy was the most common therapy (48.9%), followed by no treatment (40.2%). Compared with surgery alone, no treatment had worse OS (HR, 11.83, 95% CI: 1.41–99.56). Increasing age and female sex were both associated with increased mortality.
Conclusions The most common treatment for pituitary carcinoma is surgery alone followed by no surgery. Surgery alone has significantly better OS compared with no treatment. The efficacy of radiation, chemotherapy, and neurohormonal treatments needs to be examined with prospective studies.
Keywordspituitary carcinoma - National Cancer Database - overall survival - pituitary - skull base - outcomes
- 1 Scheithauer BW, Kovacs KT, Laws Jr ER, Randall RV. Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg 1986; 65 (06) 733-744
- 2 Heaney AP. Clinical review: pituitary carcinoma: difficult diagnosis and treatment. J Clin Endocrinol Metab 2011; 96 (12) 3649-3660
- 3 Kontogeorgos G. Classification and pathology of pituitary tumors. Endocrine 2005; 28 (01) 27-35
- 4 Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009; 23 (05) 543-554
- 5 Pernicone PJ, Scheithauer BW, Sebo TJ. , et al. Pituitary carcinoma: a clinicopathologic study of 15 cases. Cancer 1997; 79 (04) 804-812
- 6 Kaltsas GA, Grossman AB. Malignant pituitary tumours. Pituitary 1998; 1 (01) 69-81
- 7 Scheithauer BW, Kurtkaya-Yapicier O, Kovacs KT, Young Jr WF, Lloyd RV. Pituitary carcinoma: a clinicopathological review. Neurosurgery 2005; 56 (05) 1066-1074 , discussion 1066–1074
- 8 Kaltsas GA, Nomikos P, Kontogeorgos G, Buchfelder M, Grossman AB. Clinical review: diagnosis and management of pituitary carcinomas. J Clin Endocrinol Metab 2005; 90 (05) 3089-3099
- 9 Landman RE, Horwith M, Peterson RE, Khandji AG, Wardlaw SL. Long-term survival with ACTH-secreting carcinoma of the pituitary: a case report and review of the literature. J Clin Endocrinol Metab 2002; 87 (07) 3084-3089
- 10 Touma W, Hoostal S, Peterson RA, Wiernik A, SantaCruz KS, Lou E. Successful treatment of pituitary carcinoma with concurrent radiation, temozolomide, and bevacizumab after resection. J Clin Neurosci 2017; 41: 75-77
- 11 Raverot G, Burman P, McCormack A. , et al; European Society of Endocrinology. European Society of Endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol 2018; 178 (01) G1-G24
- 12 Roncaroli F, Scheithauer BW, Young WF. , et al. Silent corticotroph carcinoma of the adenohypophysis: a report of five cases. Am J Surg Pathol 2003; 27 (04) 477-486
- 13 Ragel BT, Couldwell WT. Pituitary carcinoma: a review of the literature. Neurosurg Focus 2004; 16 (04) E7
- 14 Yoo F, Kuan EC, Heaney AP, Bergsneider M, Wang MB. Corticotrophic pituitary carcinoma with cervical metastases: case series and literature review. Pituitary 2018; 21 (03) 290-301
- 15 Kaltsas GA, Mukherjee JJ, Plowman PN, Monson JP, Grossman AB, Besser GM. The role of cytotoxic chemotherapy in the management of aggressive and malignant pituitary tumors. J Clin Endocrinol Metab 1998; 83 (12) 4233-4238
- 16 Hansen TM, Batra S, Lim M. , et al. Invasive adenoma and pituitary carcinoma: a SEER database analysis. Neurosurg Rev 2014; 37 (02) 279-285 , discussion 285–286
- 17 Raverot G, Wierinckx A, Dantony E. , et al; HYPOPRONOS. Prognostic factors in prolactin pituitary tumors: clinical, histological, and molecular data from a series of 94 patients with a long postoperative follow-up. J Clin Endocrinol Metab 2010; 95 (04) 1708-1716
- 18 Scheithauer BW, Fereidooni F, Horvath E. , et al. Pituitary carcinoma: an ultrastructural study of eleven cases. Ultrastruct Pathol 2001; 25 (03) 227-242
- 19 Bengtsson D, Schrøder HD, Andersen M. , et al. Long-term outcome and MGMT as a predictive marker in 24 patients with atypical pituitary adenomas and pituitary carcinomas given treatment with temozolomide. J Clin Endocrinol Metab 2015; 100 (04) 1689-1698
- 20 Bode H, Seiz M, Lammert A. , et al. SOM230 (pasireotide) and temozolomide achieve sustained control of tumour progression and ACTH secretion in pituitary carcinoma with widespread metastases. Exp Clin Endocrinol Diabetes 2010; 118 (10) 760-763
- 21 Lenders N, McCormack A. Malignant transformation in non-functioning pituitary adenomas (pituitary carcinoma). Pituitary 2018; 21 (02) 217-229
- 22 Delgrange E, Vasiljevic A, Wierinckx A. , et al. Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. Eur J Endocrinol 2015; 172 (06) 791-801
- 23 In H, Bilimoria KY, Stewart AK. , et al. Cancer recurrence: an important but missing variable in national cancer registries. Ann Surg Oncol 2014; 21 (05) 1520-1529