Medical Scientist Training Program, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.
Clin Neurol Neurosurg. 2022 Nov;222:107455. doi: 10.1016/j.clineuro.2022.107455. Epub 2022 Sep 27.
Clinical and sociodemographic predictors of pituitary adenoma (PA) patients undergoing active surveillance (AS) versus definitive treatment (DT) are poorly understood.
This population-based analysis aims to identify clinical and sociodemographic predictors of undergoing AS versus DT.
The National Cancer Database (NCDB) was utilized to query PA patients diagnosed from 2010 to 2015 undergoing AS or DT. Independent-samples t-test and chi-squared test were used to compare differences in patient baseline characteristics and a stepwise binary logistic regression was performed to elucidate factors implicated in undergoing AS.
The cohort consisted of 30,233 PA patients, with 5147 (17.0%) patients undergoing AS. On multivariable logistic regression, patients aged ≥ 65 years (OR=1.65; p < 0.001), African American race (OR=1.12; p = 0.035), having government insurance (OR=1.45; p < 0.001) or those uninsured (OR=1.58; p < 0.001) were significantly more likely to undergo AS compared to DT, while patients with larger tumors (OR=0.90; p < 0.001), receiving treatment at academic facilities (OR=0.75; p < 0.001), and living in West regions of the United States (OR=0.59; p < 0.001) were significantly less likely to undergo AS compared to DT.
Significant sociodemographic disparities exist in patient selection for undergoing AS versus DT, which may modify patient clinical outcomes.
接受主动监测（AS）与确定性治疗（DT）的垂体腺瘤（PA）患者的临床和社会人口统计学预测因素了解甚少。
本基于人群的分析旨在确定接受 AS 与 DT 的临床和社会人口统计学预测因素。
利用国家癌症数据库（NCDB）查询 2010 年至 2015 年期间诊断为 PA 并接受 AS 或 DT 的患者。采用独立样本 t 检验和卡方检验比较患者基线特征的差异，并进行逐步二项逻辑回归以阐明接受 AS 的相关因素。
该队列包括 30233 例 PA 患者，其中 5147 例（17.0%）患者接受 AS。多变量逻辑回归显示，年龄≥65 岁的患者（OR=1.65；p<0.001）、非裔美国人（OR=1.12；p=0.035）、有政府保险（OR=1.45；p<0.001）或无保险（OR=1.58；p<0.001）的患者更有可能接受 AS 治疗，而肿瘤较大的患者（OR=0.90；p<0.001）、在学术医疗机构接受治疗的患者（OR=0.75；p<0.001）以及居住在美国西部的患者（OR=0.59；p<0.001）接受 AS 治疗的可能性明显低于 DT。
在选择接受 AS 与 DT 的患者时，存在显著的社会人口统计学差异，这可能会改变患者的临床结局。
