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World Neurosurg. 2019 Sep 4. pii: S1878-8750(19)32365-4. doi: 10.1016/j.wneu.2019.08.209. [Epub ahead of print]

Recurrence rate and prognostic factors for the adult craniopharyngiomas in long-term follow-up.

Author information

1
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
2
Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.
3
Pituitary Center, Seoul National University Hospital, Seoul, Republic of Korea; Devision of Endocrinology and Metabolism, Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea; Pituitary Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kimyh96@snu.ac.kr.

Abstract

BACKGROUND:

Craniopharyngiomas show a high recurrence rate despite their pathologically benign nature. Thus, we analyzed the clinical features to elucidate the prognostic factors for the recurrence of craniopharyngiomas in adults with long-term follow-up.

METHODS:

This retrospective study reviewed and analyzed the preoperative features, surgical results and tumor recurrence of patients who underwent an operation at a single institution from 2004 to 2013.

RESULTS:

This study analyzed the results of 64 consecutive adult patients, and the median follow-up period was 83.5 months (range, 9-163 months). Ten patients had a history of surgery, while 4 had a history of adjuvant radiation. Retrochiasmatic tumors (n=51, 79.7%) were more common than prechiasmatic tumors. Operations were performed via the transcranial approach (TCA) in 31 (48.4%) patients and transsphenoidal approach (TSA) in 33. Gross total removal (GTR) was achieved in 44 (68.8%) patients, and TSA showed a higher GTR rate than TCA did (97.0% versus 38.7%, p<0.001). Adjuvant radiotherapy was performed in 8 patients, and radiosurgery was performed in 2. Recurrence was identified in 25 (39.1%) patients in 45.0 months of the median time to recurrence. The overall actuarial 5- and 7-year progression-free survival rates were 71.8 and 63.6%, respectively. Multivariate analysis revealed that supra- and subdiaphragmatic tumor locations and subtotal removal were risk factors for long-term tumor recurrence.

CONCLUSIONS:

The long-term recurrence rate of craniopharyngiomas was high; therefore, long-term regular follow-up is mandatory. Adjuvant irradiation for remnant tumors showed a long-term tumor control rate comparable to that of completely removed tumors.

KEYWORDS:

Craniopharyngioma; long-term; recurrence; risk factor

PMID:
31493596
DOI:
10.1016/j.wneu.2019.08.209

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