Risk factors for recurrence in pediatric craniopharyngioma: impact of extensive tumor involvement and growth hormone therapy in a multicenter cohort.
In a retrospective 10-institution cohort of 254 pediatric craniopharyngioma patients, extensive tumor involvement on diagnostic MRI was associated with recurrence, while postoperative growth hormone therapy was not significantly associated with recurrence.
Open original publication →What the AI sees
In a retrospective 10-institution cohort of 254 pediatric craniopharyngioma patients, extensive tumor involvement on diagnostic MRI was associated with recurrence, while postoperative growth hormone therapy was not significantly associated with recurrence.
Research significance
The evidence supports extensive radiologic involvement as a potential recurrence-risk marker and provides observational reassurance regarding growth hormone therapy; it may be inferred—but is not established—that risk-adapted surveillance and appropriately selected hormone replacement could improve long-term management without increasing recurrence.
Source abstract
PURPOSE: Craniopharyngioma is a benign sellar tumor that accounts for 4%-9% of pediatric intracranial tumors and is associated with substantial endocrine morbidity. It has a high recurrence rate, and several predictors have been reported; however, these risk factors have not been fully consistent across studies. This study evaluated clinically relevant risk factors for recurrence in pediatric craniopharyngioma using a multicenter cohort. METHODS: This retrospective study included patients diagnosed with craniopharyngioma before 18 years of age at 10 institutions in Korea. Clinical characteristics, magnetic resonance imaging (MRI) findings at diagnosis, postoperative hormonal test results, and growth hormone treatment (GHT) were evaluated. RESULTS: A total of 254 patients were analyzed. The median age at diagnosis was 8.21 years (IQR, 5.20-11.28), and the median follow-up duration was 11.22 years (6.32-16.60). Tumor recurrence occurred in 66 patients (26.0%) after a median of 3.12 years (2.17-5.08). Among these patients, 45 experienced one recurrence, 15 experienced two recurrences, four experienced three recurrences, and two experienced five recurrences. In multivariate analysis, extensive tumor involvement on MRI at diagnosis-defined as involvement of the sphenoid sinus, frontal base, or brainstem-was significantly associated with recurrence (hazard ratio=6.16, p=0.038). Postoperative GHT was not significantly associated with recurrence (p=0.671). CONCLUSION: Extensive radiologic tumor involvement at diagnosis may be a predictor of recurrence in pediatric craniopharyngioma, whereas postoperative GHT was not associated with an increased risk of recurrence. These real-world findings highlight the importance of careful surveillance in patients with extensive tumor involvement and may help guide clinical decision-making regarding GHT.