Carey Ryan M, Kuan Edward C, Workman Alan D, Patel Neil N, Kohanski Michael A, Tong Charles C L, Chen Jinbo, Palmer James N, Adappa Nithin D, Brant Jason A
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2020 Apr;81(2):180-186. doi: 10.1055/s-0039-1683435. Epub 2019 Mar 15.
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. 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). 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. 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.
垂体癌是一种罕见的疾病，英文文献报道的病例总数不足200例。分析国家癌症数据库（NCDB）的人群水平数据为研究这种了解甚少的肿瘤类型提供了机会。
查询NCDB中与垂体癌对应的部位、组织学和转移编码。进行统计分析以确定与总生存期（OS）相关的因素。
共有92例垂体癌患者符合纳入标准。所有患者的1年和5年总生存率分别为93.3%（95%置信区间[CI]：88.2 - 98.6%）和80.0%（95%CI：71.6 - 89.4%）。具有侵袭性原发性肿瘤行为的患者1年和5年总生存率分别为69.2%（95%CI：48.2 - 99.5%）和52.7%（95%CI：31.2 - 89.2%）。多变量分析表明，与良性原发性行为相比，侵袭性行为增加了全因死亡率（风险比[HR]，1.296，95%CI：15.1 - ＞2000）。未进行辅助放疗或化疗的手术是最常见的治疗方法（48.9%），其次是未治疗（40.2%）。与单纯手术相比，未治疗的总生存期更差（HR，11.83，95%CI：1.41 - 99.56）。年龄增加和女性性别均与死亡率增加相关。
垂体癌最常见的治疗方法是单纯手术，其次是不手术。与未治疗相比，单纯手术的总生存期明显更好。放疗、化疗和神经激素治疗的疗效需要通过前瞻性研究来检验。
