Craniopharyngioma-related death represents the most common cause of early deaths in both pediatric and adult patients. GTR and adjuvant RT do not appear to have a significant impact on OS within 5 years of diagnosis. Older age, black race, and adamantinomatous/papillary histologies are significant prognostic factors for early deaths after the diagnosis.
Yuan J. Rao, MD, Stephanie Perkins, MD, Jiayi Huang, MD; Washington University
PURPOSE: Craniopharyngioma is a locally invasive tumor that is challenging to resect, and the roles of aggressive surgery or adjuvant radiation therapy (RT) are unclear. The current study analyzed the Surveillance, Epidemiology, and End Results (SEER) registry to identify prognostic factors of early deaths after the diagnosis of craniopharyngioma, as well as to examine the impact of gross total resection (GTR) or adjuvant RT on overall survival (OS).
METHODS: The SEER database was queried for craniopharyngioma patients from 2004 to 2011. Inclusion criteria included histologically confirmed craniopharyngioma with adequate information on age, surgical extent, and adjuvant RT. Patients who were aged < 3 years or > 69 years were excluded. Follow-up time was determined from the time of diagnosis. Cox proportional hazards models were used for univariate analysis (UVA) and multivariate analysis (MVA). OS rates were calculated using the Kaplan-Meier method and compared between groups using log-rank statistics.
RESULTS: A total of 788 patients met the inclusion criteria, and the median follow-up was 38 months (range: 1–95 mo). Nine pediatric patients died within 5 years of diagnosis, with 78% attributed to craniopharyngioma. Further, 81 adult patients died within 5 years of diagnosis, and the two most common causes of death were craniopharyngioma (36%) and cardiac/diabetic causes (31%). On both UVA and MVA, older age (hazard ratio [HR] = 1.03; 95% confidence interval [CI], 1.02–1.04), black race (HR = 3.52; 95% CI, 2.29–5.40), adamantinomatous histology (HR = 1.84; 95% CI, 1.19–2.84), and papillary histology (HR = 2.07; 95% CI, 1.12–3.82) were significant predictors of worse OS. In contrast, gender, GTR, adjuvant RT, and tumor size were not significantly correlated with OS. Adult patients (aged ≥ 18 yr) had significantly worse 5-year OS than pediatric patients (80% vs 95%, respectively; P < .01). Patients of black race had significantly worse 5-year OS than patients of other races (67% vs 87%, respectively; P < .01). Adamantinomatous histology and papillary histology were associated with worse 5-year OS than classic craniopharyngioma histology (80% and 77% vs 88%, respectively; P = .05). Patients with GTR had a 5-year OS of 83%, while those with biopsy or subtotal resection had a 5-year OS of 86% (P = .26). Patients with adjuvant RT had a 5-year OS of 89%, while those who did not receive RT had a 5-year OS of 83% (P = 0.15).
CONCLUSIONS: Craniopharyngioma-related death represents the most common cause of early deaths in both pediatric and adult patients. GTR and adjuvant RT do not appear to have a significant impact on OS within 5 years of diagnosis. Older age, black race, and adamantinomatous/papillary histologies are significant prognostic factors for early deaths after the diagnosis.
Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org