Introduction: Pituitary adenomas (PA) are the most common intrasellar tumor and have a prevalence of a prevalence of 17%, and transsphenoidal surgical approach (TSA) is the most common surgical treatment. Most patients fare well postoperatively, but a subset of patients experience a prolonged length of stay (PLOS). The aim of this study was to identify demographic and clinical factors associated with PLOS following TSA for PA.

BACKGROUND: Recent advances in treatment of malignant brain tumors have improved outcomes. However, patients continue to experience significant disability. Palliative care helps patients with advanced illnesses improve their quality of life. There is a paucity of clinical studies examining palliative care usage among patients with malignant brain tumors.OBJECTIVE: To assess if there were any patterns in palliative care utilization among patients hospitalized with malignant brain tumors.METHODS: A retrospective cohort representing hospitalizations for malignant brain tumors was created from The National Inpatient Sample (2016-2019). Palliative care utilization was identified by ICD-10 code. Univariable and multivariable logistic regression models, accounting for the sample design, were built to evaluate the demographic variables associated with palliative care consultation in all patients and fatal hospitalizations. RESULTS: 375 010 patients admitted with a malignant brain tumor were included in this study. Over the whole cohort, 15.0% of patients used palliative care. In fatal hospitalizations, Black and Hispanic patients had 28% lower odds of receiving a palliative care consultation compared with White patients (odds ratio for both = 0.72; P = .02). For fatal hospitalizations, patients insured privately were 34% more likely to use palliative care services compared with patients insured with Medicare (odds ratio = 1.34, P = .006). CONCLUSION: Palliative care is underutilized among all patients with malignant brain tumors. Within this population, disparities in utilization are exacerbated by sociodemographic factors. Prospective studies investigating utilization disparities across race and insurance status are necessary to improve access to palliative care services for this population.

Abstract Purpose: Postoperative diabetes insipidus (DI) is a known occurrence after pituitary adenoma (PA) resection. It is reported in up to 30% of procedures with associated postsurgical morbidity and prolonged length of stay. This study aimed to evaluate preoperative factors that may be associated with postoperative DI after pituitary tumor resection. Methods: Data from the 2016-2019 National Inpatient Sample (NIS) was analyzed. Diagnosis related group code was used to identify the hospitalizations for PA resection. Comorbidities were defined by the Elixhauser Comorbidity Index given ICD-10 codes. Univariable and multivariable logistic regression models, accounting for sampling design, were built to determine factors associated with postoperative DI. Results: 61,105 PA patients were included; 55,125 patients did not develop DI, whereas 5,980 patients did. Compared to White patients, Black patients (OR=1.47;p<0.001) and Hispanic patients (OR=1.34;p=0.003) experienced increased odds of postoperative DI. Older age was associated with decreased odds of postoperative DI (OR 1-year increase in age=0.98;p<0.001). Hypertension (OR=0.65;p<0.001) was associated with decreased odds of postoperative DI. Neurological disorders (OR=2.65;p<0.001), paralysis (OR=2.38;p<0.001), and hypothyroidism (OR=2.39;p<0.001) were associated with increased odds of postoperative DI. Endoscopic surgery provided no significant advantage to avoiding postoperative DI (p=0.127). Conclusions: Black and Hispanic patients had significantly increased odds of postoperative DI. Further investigation is needed to uncover the source of these disparities. Hypothyroidism and neurological conditions, likely due to tumor characteristics, increased odds of postoperative DI. Finally, this study contributed to the argument that endoscopic approach does not improve postoperative DI risk in the ongoing debate in the literature.

The oncologic outcomes for atypical meningiomas can be poor. Generally, patients that have had a prior recurrence have a substantially elevated risk of a future recurrence. Additionally, certain tumor genomic profiles have been shown as markers of poor prognosis. We sought to characterize the genomic differences between primary and recurrent tumors as well as assess if those differences had implications on recurrence. We identified primary and recurrent gross totally resected WHO grade II meningiomas with > 30 days of post-surgical follow-up at our institution. For genes with a prevalence of > 5

OBJECTIVE Prior studies have demonstrated a relationship between underlying tumor genetics and lymphocyte infiltration in meningiomas. In this study, the authors aimed to further characterize the relationship between meningioma genomics, CD4+ and CD8+ T-cell infiltration, and oncological outcomes of meningiomas. Understanding specific characteristics of the inflammatory infiltration could have implications for treatment and prognostication. METHODS Immunohistochemically stained meningioma slides were reviewed to assess the CD4+ and CD8+ cell infiltration burden. The relationship between immune cell infiltration and tumor genomics was then assessed using an adjusted ANOVA model. For a specific gene identified by the ANOVA, the relationship between that mutation and tumor recurrence was assessed using Cox regression. RESULTS In immunohistochemically stained samples from a subcohort of 25 patients, the mean number of CD4+ cells was 42.2/400× field and the mean number of CD8+ cells was 69.8/400× field. Elevated CD8+ cell infiltration was found to be associated with the presence of a mutation in the gene encoding for DNA polymerase epsilon, POLE (51.6 cells/hpf in wild-type tumors vs 95.9 cells/hpf in mutant tumors; p = 0.0199). In a retrospective cohort of 173 patients, the presence of any mutation in POLE was found to be associated with a 46% reduction in hazard of progression (HR 0.54, 95% CI 0.311-0.952; p = 0.033). The most frequent mutation was a near-C-terminal nonsense mutation. CONCLUSIONS A potential association was found between mutant POLE and both an increase in CD8+ cell infiltration and progression-free survival. The predominant mutation was found outside of the known exonuclease hot spot; however, it was still associated with a slight increase in mutational burden, CD8+ cell infiltration, and progression-free survival. Alterations in gene expression, resulting from alterations in POLE, may yield an increased presentation of neoantigens, and, thus, greater CD8+ cell-mediated apoptosis of neoplastic cells. These findings have suggested the utility of checkpoint inhibitors in the treatment of POLE-mutant meningiomas.

PURPOSE:Meningiomas occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for those 85+. Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course to inform management decisions in this population. We therefore sought to determine age-stratified relationships between tumour genomics and recurrence after resection of atypical meningiomas. METHODS:We identified 137 primary and recurrent Grade 2 meningiomas from our existing meningioma genomic sequencing database. We examined the differential distribution of genomic alterations in those older than 65 compared to younger. We then performed an age stratified survival analysis to model recurrence for a mutation identified as differentially present. RESULTS:In our cohort of 137 patients with grade 2 meningiomas, alterations in NF2 were present at a higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; recurrence adjusted p-value =0.04). There was no association between the presence of NF2 and recurrence in the whole cohort. In the age-stratified model for those less than 65 years old, there was again no relationship. For patients in the older age stratum, there is a relationship between NF2 and worsened recurrence outcomes (HR = 3.64 (1.125 - 11.811); p = 0.031). CONCLUSIONS:We found that mutations in NF2 were more common in older adults. Further, the presence of mutant NF2 was associated with an increased risk of recurrence in older adults.