Older Age is Correlated with a Better Progression Free Survival Despite Less Aggressive Resection in Non-Functioning Pituitary Adenomas

Introduction: Non-functioning pituitary adenomas (NFAs) present at a wide range of ages; it is possible that variable outcomes are based on patient age at presentation. This study aimed to explore long-term outcomes of patients with NFAs following endonasal transsphenoidal surgery (ETS), considering age stratification.

Methods: This retrospective study enrolled 228 patients with NFAs who underwent ETS, with a median follow-up period of 63 months. The outcomes included progression-free survival (PFS) rates, neurological and endocrinologic outcomes. Age-stratified Kaplan–Meier and Cox proportional hazards analyses were performed. Patients were classified into four age groups: < 49, 50–59, 60–69, and ≥70 years.

Results: Age-stratified analysis showed a significant correlation between age and PFS in NFAs (the 5-year PFS rates were 58.3% in the < 49 group, 68.7% in the 50–59 group, 80.9% in the 60–69 group, and 83.4% in the ≥70 group, log-rank test; p = 0.003). Multivariable analysis demonstrated that older age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02–1.05; p = 0.001), smaller maximum tumor diameter (HR, 0.77; 95% CI, 0.60–0.99; p = 0.036) and gross total resection (HR, 8.55; 95% CI, 3.90–18.75; p = 0.001) were significantly associated with longer PFS. Multivariable logistic regression analysis demonstrated that only younger age was associated with postoperative improvement of male hypogonadism (HR, 0.91; 95% CI, 0.84–0.99; p = 0.019). Other postoperative neurological and endocrinologic outcomes were not significantly associated with age.

Conclusion : Older patients with NFA treated with ETS demonstrated a longer PFS. Of endocrinologic outcomes studied, only male hypogonadism improvement was associated with younger patient’s age.