Surgical management in very elderly patients with pituitary adenoma: a multivariable assessment of the surveillance,...

The management of pituitary adenomas in very elderly patients (age ≥ 85 years) remains challenging due to age-related frailty and variability in treatment tolerance. This study aimed to identify clinical and sociodemographic factors associated with survival in patients age ≥ 85 years with pituitary adenoma and assess the plausibility of surgical resection.

Patients aged 85 and up (very elderly cohort) were queried from the SEER database. Additionally, patients from the age range of 75-84 (elderly cohort) were queried for comparisons. Demographic variables, adenoma size, and treatment variables were assessed, and differences were identified using a Chi-squared tests for independence and two-sample t-tests. Differences in survival were assessed using multivariable Cox proportional hazards models stratified by age cohort. Kaplan-Meier plots were generated to assess survival differences among treatment groups in the very elderly cohort.

Across all cohorts, subtotal resection and female sex were independently associated with improved survival and age was associated with worse survival. For the very elderly cohort, adenoma size (HR = 1.004; p = 0.005) was associated with worse overall survival, while female sex (HR = 0.656; p < 0.001) and subtotal resection (HR = 0.557; p = 0.005) were associated with increased overall survival. Black race was associated with worse survival in the 75-84 elderly cohort only (HR = 1.479; p < 0.001).

In patients ≥ 85 years of age with pituitary adenoma, surgical resection appears to provide an overall benefit to survival and should be considered among other factors.