Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., San Francisco, CA 94117, USA.
J Neurooncol. 2011 Feb;101(3):463-76. doi: 10.1007/s11060-010-0265-y. Epub 2010 Jun 10.
Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson's chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33-41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ(2) P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05-5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available.
颅咽管瘤是局部侵袭性肿瘤，通常集中在鞍区和鞍上区域，靠近许多调节内分泌、行为和视觉功能的关键神经和血管结构。本研究旨在总结和比较颅咽管瘤治疗相关发病率的已发表文献。我们对已发表的英文文献进行了全面检索，以确定发表手术治疗颅咽管瘤患者结果数据的研究。使用 Pearson 卡方检验比较内分泌、血管、神经和视觉并发症的发生率，并将感兴趣的协变量拟合到多变量逻辑回归模型中。在我们的数据集里，540 名患者接受了肿瘤切除术。138 名患者仅接受了活检，然后接受了某种形式的放疗。这些研究中所有患者的平均总随访时间为 54 ± 1.8 个月。所有接受肿瘤切除术的患者新发内分泌疾病的总体发生率为 37%（95%CI = 33-41）。与单独接受次全切除术（STR）或 STR+放疗（XRT）的患者相比，接受肿瘤全切除（GTR）的患者发生至少一种内分泌疾病的几率高出 2.5 倍（52%比 19%比 20%，χ(2)P < 0.00001）。多变量分析显示，与 STR+XRT 相比，GTR 显著增加了发生内分泌疾病的风险（OR = 3.45，95%CI = 2.05-5.81，P < 0.00001），控制了研究规模和下丘脑受累的存在。与 GTR 或 STR 相比，STR 后接受 XRT 的患者视觉结局更差（GTR = 3.5%比 STR = 2.1%比 STR+XRT = 6.4%，P = 0.11）。鉴于获得此类肿瘤治疗的 1 类数据存在困难，本研究可作为这些患者预期结果的估计，并在获得这些数据之前指导决策。
