Caleigh S Roach, Vratko Himic, Richa Dahake, Khushi H Shah, Victor M Lu, Daniel Kreatsoulas, Arman Jahangiri, Carmen V Villabona, Zoukaa B Sargi, Ashish H Shah, Carolina G Benjamin, Ricardo J Komotar, Michael E Ivan
Race- and ethnicity-associated differences emerged mainly at baseline presentation and in postoperative trajectory, whereas durable biochemical remission converged across groups; Black subgroup analyses were limited by small sample size and residual imbalance after weighting. These hypothesis-generating findings support postoperative surveillance tailored to where differences emerge rather than to ultimate remission and require validation in larger multicenter cohorts.
PURPOSE: This study aimed to determine where along the surgical care pathway race- and ethnicity-associated differences emerge after primary transsphenoidal surgery (TSS) for Cushing's disease (CD).
METHODS: Single-center retrospective cohort of 104 adults undergoing primary TSS for pathologically confirmed CD (2013-2024): 44 White non-Hispanic (WnH), 44 Hispanic, and 16 Black. Preoperative phenotype, perioperative complications, biochemical remission, radiographic persistence, and reintervention were compared across groups using unweighted statistics (Kruskal-Wallis, chi-square or Fisher's exact tests). Sensitivity analysis used inverse probability of treatment weighting (IPTW) with a multinomial propensity model; Black subgroup comparisons were considered exploratory.
RESULTS: Hispanic patients lived closer to the center (p = 0.003) and presented with milder disease. Black patients were younger (p = 0.003), with higher BMI (p = 0.033) and near-uniformly solid tumors (94%; p = 0.040). Postoperative arginine vasopressin deficiency was less frequent in Hispanic than WnH patients (25% vs. 55%; p = 0.005). Durable remission rates were comparable (WnH 79%, Hispanic 81%, Black 88%), though Black patients had higher day-1 cortisol and delayed remission on IPTW sensitivity, higher radiographic persistence (38% vs. 21%), and higher crude reintervention (25% vs. 4.5%; p = 0.036). On exploratory IPTW analysis, Hispanic patients also showed shorter reintervention-free survival despite favorable baseline features (IPTW HR 4.20; p = 0.036), a signal not apparent in unadjusted analysis.
CONCLUSION: Race- and ethnicity-associated differences emerged mainly at baseline presentation and in postoperative trajectory, whereas durable biochemical remission converged across groups; Black subgroup analyses were limited by small sample size and residual imbalance after weighting. These hypothesis-generating findings support postoperative surveillance tailored to where differences emerge rather than to ultimate remission and require validation in larger multicenter cohorts.