Department of Neurosurgery, All India Institute of Medical Science, Veerbhadra Road, Rishikesh, Uttarakhand, 249203, India.
Department of Neurosurgery, Sri Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India.
Pituitary. 2020 Oct;23(5):515-525. doi: 10.1007/s11102-020-01053-z.
Implication of the tumor size on oncological and functional outcomes of craniopharyngioma is inconsistently reported. The aim of this study is to assess the postoperative outcome of giant craniopharyngiomas (> 4 cm in diameter) and to elucidate the impact of tumor size on various outcome parameters and survival.
Forty-four patients (children aged ≤ 18 years: 25; adults: 16) with giant craniopharyngioma, operated between January 2001 and December 2015, were included in this study. Various outcomes, progression-free survival (PFS) and overall survival (OS) were calculated.
Gross total resection (GTR) was achieved in 17 (39%) and subtotal resection (STR) in 27 (61%) patients. Eleven patients (25%) received radiotherapy (RT) after STR. Postoperatively, new cranial nerve and motor deficits were noted in 12 (27%) and 9 (20%) patients, respectively. Tumor recurrence following GTR and STR without adjuvant RT was diagnosed in 3 (17%), and 5 (38%) patients, respectively. Following STR with RT, one (9%) experienced recurrence. PFS at 5-, and 10- year following GTR, STR, and STR + RT was 80.8%, 45.4%, and 90%, respectively. At 5- and 10- year, OS was 86.5%, 77.9% and 100% following GTR, STR, and STR + RT, respectively. The rate of GTR was significantly lower in patients with giant tumors (39% vs. 62%; Chi-square test, p value 0.008). Postoperatively, neurological deficit (20%), hypopituitarism (95%) and hypothalamic dysfunction (26%) were significantly higher for giant craniopharyngiomas. Hazards of recurrence were not significant between giant and non-giant tumors (hazard ratio 1.86; 95% CI 0.94-3.68; p 0.07). There was no significant difference in OS between the patients with giant and non-giant tumors (log-rank test 2.1; p value 0.14).
Tumor size should be considered as an important predictor of the postoperative functional outcome. Although the rate of GTR is less than that of small tumors, the recurrence rate, progression-free survival, and overall survival of the patients with giant tumor are comparable to non-giant tumors.
颅咽管瘤的肿瘤大小对肿瘤学和功能结果的影响报道不一致。本研究旨在评估巨大颅咽管瘤（直径>4cm）的术后结果，并阐明肿瘤大小对各种结果参数和生存的影响。
本研究纳入了 2001 年 1 月至 2015 年 12 月期间接受手术治疗的 44 例（儿童≤18 岁：25 例；成人：16 例）巨大颅咽管瘤患者。计算了各种结果、无进展生存期（PFS）和总生存期（OS）。
17 例（39%）患者行肿瘤全切除（GTR），27 例（61%）患者行次全切除（STR）。11 例（25%）患者在 STR 后接受放疗（RT）。术后，12 例（27%）和 9 例（20%）患者出现新的颅神经和运动功能障碍。GTR 和 STR 后未行辅助 RT 的患者肿瘤复发分别为 3 例（17%）和 5 例（38%）。STR 后行 RT 的患者中，1 例（9%）出现复发。GTR、STR 和 STR+RT 后 5 年和 10 年的 PFS 分别为 80.8%、45.4%和 90%。5 年和 10 年时，GTR、STR 和 STR+RT 的 OS 分别为 86.5%、77.9%和 100%。在巨大肿瘤患者中，GTR 的比例明显低于非巨大肿瘤（39% vs. 62%；卡方检验，p 值=0.008）。术后，巨大颅咽管瘤患者的神经功能缺损（20%）、垂体功能减退（95%）和下丘脑功能障碍（26%）发生率明显更高。复发的危险在巨大肿瘤和非巨大肿瘤之间没有显著差异（危险比 1.86；95%CI 0.94-3.68；p=0.07）。巨大肿瘤和非巨大肿瘤患者的 OS 无显著差异（对数秩检验 2.1；p 值=0.14）。
肿瘤大小应被视为术后功能结果的重要预测因素。尽管 GTR 的比例低于小肿瘤，但巨大肿瘤患者的复发率、无进展生存期和总生存期与非巨大肿瘤相似。
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