Birkenbeuel Jack L, Lehrich Brandon M, Goshtasbi Khodayar, Abiri Arash, Hsu Frank P K, Kuan Edward C
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92868, USA.
Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Cancers (Basel). 2022 Oct 30;14(21):5348. doi: 10.3390/cancers14215348.
We characterized the clinical and sociodemographic factors predictive of surgery refusal in pituitary adenoma (PA) patients. We queried the National Cancer Database (NCDB) to identify adult PA patients treated from 2004−2015 receiving or refusing surgery. Multivariate logistic regression and Cox proportional-hazards analysis identified clinical and/or sociodemographic factors predictive of surgery refusal or mortality, respectively. Of the 34,226 patients identified, 280 (0.8%) refused surgery. On multivariate logistic regression, age > 65 (OR: 2.64; p < 0.001), African American race (OR: 1.70; p < 0.001), Charlson-Deyo Comorbidity (C/D) Index > 2 (OR: 1.52; p = 0.047), and government insurance (OR: 2.03; p < 0.001) or being uninsured (OR: 2.16; p = 0.03) were all significantly associated with surgery refusal. On multivariate cox-proportional hazard analysis, age > 65 (HR: 2.66; p < 0.001), tumor size > 2 cm (HR: 1.30; p < 0.001), C/D index > 1 (HR: 1.53; p < 0.001), having government insurance (HR: 1.66; p < 0.001) or being uninsured (HR: 1.67; p < 0.001), and surgery refusal (HR: 2.28; p < 0.001) were all significant predictors of increased mortality. Macroadenoma patients receiving surgery had a significant increase in overall survival (OS) compared to those who refused surgery (p < 0.001). There are significant sociodemographic factors that influence surgery refusal in PA patients. An individualized approach is warranted that considers functional status, clinical presentations, and patient choice.
我们对垂体腺瘤（PA）患者中预测手术拒绝的临床和社会人口统计学因素进行了特征分析。我们查询了国家癌症数据库（NCDB），以识别2004 - 2015年期间接受或拒绝手术治疗的成年PA患者。多变量逻辑回归和Cox比例风险分析分别确定了预测手术拒绝或死亡的临床和/或社会人口统计学因素。在识别出的34226例患者中，280例（0.8%）拒绝手术。多变量逻辑回归分析显示，年龄>65岁（比值比：2.64；p<0.001）、非裔美国人种族（比值比：1.70；p<0.001）、Charlson - Deyo合并症（C/D）指数>2（比值比：1.52；p = 0.047）以及政府保险（比值比：2.03；p<0.001）或未参保（比值比：2.16；p = 0.03）均与手术拒绝显著相关。多变量Cox比例风险分析显示，年龄>65岁（风险比：2.66；p<0.001）、肿瘤大小>2 cm（风险比：1.30；p<0.001）、C/D指数>1（风险比：1.53；p<0.001）、拥有政府保险（风险比：1.66；p<0.001）或未参保（风险比：1.67；p<0.001）以及手术拒绝（风险比：2.28；p<0.001）均是死亡率增加的显著预测因素。与拒绝手术的患者相比，接受手术的大腺瘤患者总生存期（OS）显著延长（p<0.001）。存在影响PA患者手术拒绝的显著社会人口统计学因素。有必要采取个性化方法，综合考虑功能状态、临床表现和患者选择。
