Weiner H L, Wisoff J H, Rosenberg M E, Kupersmith M J, Cohen H, Zagzag D, Shiminski-Maher T, Flamm E S, Epstein F J, Miller D C
Department of Neurosurgery, New York University Medical Center, New York.
Neurosurgery. 1994 Dec;35(6):1001-10; discussion 1010-1. doi: 10.1227/00006123-199412000-00001.
Pathological and clinical data from 56 patients operated on for craniopharyngioma since 1981 were analyzed to determine the utility of dividing patients with this tumor into distinct clinical groups based on recognized pathological type and to determine the prognostic import of brain invasion. Of the tumors in the 30 adult patients, 66% were adamantinomatous, 28% were squamous papillary, and the remainder were mixed. However, of the tumors in the 26 children, 96% were adamantinomatous and none were pure squamous papillary (P < 0.01). Forty-six percent of the children compared with 17% of the adults had brain invasion (P < 0.01). Brain invasion was present in 37% of the adamantinomatous but in only 13% of the squamous papillary tumors. Seventy-seven percent of the children underwent gross total resection (GTR) compared with 27% of the adults (P < 0.01). Sixty-three percent of the squamous papillary tumors underwent GTR compared with 54% of the adamantinomatous and mixed tumors. Follow-up ranged from 7 to 187 months (mean, 49 mo). After subtotal resection, with or without radiation therapy, 58% of the tumors recurred compared with 17% recurrence after GTR (P < 0.01), with a mean time to recurrence of 34 months. In both tumor histological types, subtotal resection was associated with a higher rate of tumor recurrence compared with gross total resection. Among the subtotally resected craniopharyngiomas, 2 of the 3 (67%) squamous papillary and 11 of the 21 (52%) adamantinomatous and mixed tumors recurred. In contrast, among the totally resected tumors, none of the 5 squamous papillary and only 5 of the 25 (20%) adamantinomatous and mixed tumors recurred. There were no significant differences in Karnofsky performance status score, mortality rate, or visual and endocrine outcomes when comparing patients based on histological tumor type. When controlling for age and extent of resection, we found that brain invasion had no significant effect on recurrence rate in totally resected tumors. Based on the limited number of patients in this series, we conclude as follows. 1) Contrary to previous reports, squamous papillary craniopharyngiomas, like adamantinomatous tumors, may recur when subtotally resected. 2) For both tumor variants, the most significant factor associated with craniopharyngioma recurrence is the extent of surgical resection rather than histopathological subtype. 3) Contrary to prior hypotheses, brain invasion in totally resected tumors does not predict higher recurrence. 4) GTR is associated with a significantly lower recurrence rate and can be achieved without sacrificing functional outcome.
对1981年以来接受颅咽管瘤手术的56例患者的病理和临床数据进行分析，以确定根据公认的病理类型将该肿瘤患者分为不同临床组的实用性，并确定脑侵犯的预后意义。在30例成年患者的肿瘤中，66%为造釉细胞瘤型，28%为鳞状乳头型，其余为混合型。然而，在26例儿童患者的肿瘤中，96%为造釉细胞瘤型，无纯鳞状乳头型（P<0.01）。46%的儿童有脑侵犯，而成人仅为17%（P<0.01）。造釉细胞瘤型肿瘤中37%有脑侵犯，而鳞状乳头型肿瘤仅13%有脑侵犯。77%的儿童接受了全切除（GTR），而成人仅为27%（P<0.01）。63%的鳞状乳头型肿瘤接受了GTR，而造釉细胞瘤型和混合型肿瘤为54%。随访时间为7至187个月（平均49个月）。次全切除后，无论有无放疗，58%的肿瘤复发，而GTR后复发率为17%（P<0.01），平均复发时间为34个月。在两种肿瘤组织学类型中，次全切除与全切除相比，肿瘤复发率更高。在次全切除的颅咽管瘤中，3例鳞状乳头型中的2例（67%）以及21例造釉细胞瘤型和混合型中的11例（52%）复发。相反，在全切除的肿瘤中，5例鳞状乳头型无一复发，25例造釉细胞瘤型和混合型中仅5例（20%）复发。根据肿瘤组织学类型比较患者时，卡氏功能状态评分、死亡率或视觉和内分泌结果无显著差异。在控制年龄和切除范围后，我们发现脑侵犯对全切除肿瘤的复发率无显著影响。基于本系列有限的患者数量，我们得出以下结论。1）与先前报道相反，鳞状乳头型颅咽管瘤与造釉细胞瘤型肿瘤一样，次全切除后可能复发。2）对于两种肿瘤变体，与颅咽管瘤复发相关的最显著因素是手术切除范围而非组织病理学亚型。3）与先前假设相反，全切除肿瘤中的脑侵犯并不能预测更高的复发率。4）GTR与显著较低的复发率相关，且可在不牺牲功能结果的情况下实现。
