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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

Nathan J. Wallace 
1   Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts, United States
,
Anand K. Devaiah 
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
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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

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

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Amar AP, Hinton DR, Krieger MD, Weiss MH. Invasive pituitary adenomas: significance of proliferation parameters. Pituitary 1999; 2 (02) 117-122
    CrossrefPubMedSearch in Google Scholar
  • 2 Lenders N, McCormack A. Malignant transformation in non-functioning pituitary adenomas (pituitary carcinoma). Pituitary 2018; 21 (02) 217-229
    CrossrefPubMedSearch in Google Scholar
  • 3 Heaney AP. Clinical review: pituitary carcinoma: difficult diagnosis and treatment. J Clin Endocrinol Metab 2011; 96 (12) 3649-3660
    CrossrefPubMedSearch in Google Scholar
  • 4 Ragel BT, Couldwell WT. Pituitary carcinoma: a review of the literature. Neurosurg Focus 2004; 16 (04) E7
    CrossrefPubMedSearch in Google Scholar
  • 5 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
    CrossrefPubMedSearch in Google Scholar
  • 6 Heaney A. Management of aggressive pituitary adenomas and pituitary carcinomas. J Neurooncol 2014; 117 (03) 459-468
    CrossrefPubMedSearch in Google Scholar
  • 7 Oh MC, Tihan T, Kunwar S, Blevins L, Aghi MK. Clinical management of pituitary carcinomas. Neurosurg Clin N Am 2012; 23 (04) 595-606
    CrossrefPubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Raappana A, Koivukangas J, Ebeling T, Pirilä T. Incidence of pituitary adenomas in Northern Finland in 1992-2007. J Clin Endocrinol Metab 2010; 95 (09) 4268-4275
    CrossrefPubMedSearch in Google Scholar
  • 10 Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009; 23 (05) 543-554
    CrossrefPubMedSearch in Google Scholar
  • 11 Obama B. United States health care reform: progress to date and next steps. JAMA 2016; 316 (05) 525-532
    CrossrefPubMedSearch in Google Scholar
  • 12 Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the affordable care act. JAMA 2015; 314 (04) 366-374
    CrossrefPubMedSearch in Google Scholar
  • 13 Sabik LM, Adunlin G. The ACA and cancer screening and diagnosis. Cancer J 2017; 23 (03) 151-162
    CrossrefPubMedSearch in Google Scholar
  • 14 Mesquita-Neto JWB, Cmorej P, Mouzaihem H, Weaver D, Kim S, Macedo FI. Disparities in access to cancer surgery after Medicaid expansion. Am J Surg 2020; 219 (01) 181-184
    CrossrefPubMedSearch in Google Scholar
  • 15 Han X, Zang Xiong K, Kramer MR, Jemal A. The affordable care act and cancer stage at diagnosis among young adults. J Natl Cancer Inst 2016; 108 (09) djw058
    CrossrefPubMedSearch in Google Scholar
  • 16 Surveillance E, Results E. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER∗Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2018 Sub (1975–2016 varying) - Linked To County Attributes - Total U.S., 1969–2017 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2019, based on the November 2018 submission
    PubMed
  • 17 National Cancer Institute: Surveillance, Epidemiology, and End Results Program. SEER*Stat software. Accessed November 13, 2020 at: seer.cancer.gov/seerstat
    PubMed
  • 18 IBM Corp. IBM SPSS Statistics for Windows, Version 25.0.0.2. Armonk, NY: IBM Corp.; 2018
    Search in Google Scholar
  • 19 Fernandez A, Karavitaki N, Wass JAH. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 2010; 72 (03) 377-382
    CrossrefPubMedSearch in Google Scholar
  • 20 Nilsson B, Gustavasson-Kadaka E, Bengtsson B-Å, Jonsson B. Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality. J Clin Endocrinol Metab 2000; 85 (04) 1420-1425
    PubMedSearch in Google Scholar
  • 21 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
    PubMedSearch in Google Scholar
  • 22 Pernicone PJ, Scheithauer BW, Sebo TJ. et al. Pituitary carcinoma: a clinicopathologic study of 15 cases. Cancer 1997; 79 (04) 804-812
    CrossrefPubMedSearch in Google Scholar
  • 23 Koyama J, Ikeda K, Shose Y, Kimura M, Obora Y, Kohmura E. Long-term survival with non-functioning pituitary carcinoma - case report -. Neurol Med Chir (Tokyo) 2007; 47 (10) 475-478
    CrossrefPubMedSearch in Google Scholar
  • 24 Vaquero J, Herrero J, Cincu R. Late development of frontal prolactinoma after resection of pituitary tumor. J Neurooncol 2003; 64 (03) 255-258
    CrossrefPubMedSearch in Google Scholar
  • 25 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
    CrossrefPubMedSearch in Google Scholar
  • 26 Noone A-M, Lund JL, Mariotto A. et al. Comparison of SEER treatment data with medicare claims. Med Care 2016; 54 (09) e55-e64
    CrossrefPubMedSearch in Google Scholar