Survival in Patients With Pituitary Carcinoma

OBJECTIVE: Pituitary carcinoma (PC) is defined by the presence of metastasis from a pituitary tumour. PC is rare, therefore information regarding survival and factors influencing survival are limited. We sought to assess overall survival following the diagnosis of PC and to determine factors associated with outcome. DESIGN: Retrospective case series. PATIENTS: Patients with PC who attended the Mayo clinic between 1997 and 2025. MEASUREMENTS: Information regarding patient demographics, tumour characteristics, management and outcomes were extracted. RESULTS: In total 25 patients (11 women, 44%) were diagnosed with PC (median age 56 years, range, 44-78). The most common cell type was a corticotroph tumour (n = 15, 60%). All but one patient had pituitary directed surgery and all received pituitary adenoma (PA) directed radiation therapy. Metastases were identified a median 6 years (range, 1-32) after initial PA diagnosis. At last follow-up, 10 (40%) patients were alive, 12 (48%) died of PC, and 3 (12%) died from other causes. The median survival time of patients from PC diagnosis was 3 years. The 1-, 5- and 10-year survival rates were 59%, 37% and 15%, respectively. Increased survival probability was associated with temozolomide treatment (n = 9) at some point in treatment plan (p = 0.026), the use of systemic therapy vs locoregional treatment (p = 0.045), female sex (p = 0.011), and in nonfunctional tumours (p = 0.023). CONCLUSION: PC carries a poor prognosis, with a median survival of only 3 years. Improved survival was associated with temozolomide exposure, female sex, and nonfunctional tumour subtype and underscores the prognostic relevance of tumour biology and treatment approach.