ICEECE2012 Poster Presentations Pituitary Clinical (183 abstracts)
Markers of recurrence and long-term morbidity in craniopharyngioma
A. Gautier 1 , A. Godbout 3 , C. Grosheny 1 , I. Tejedor 1 , M. Coudert 1 , C. Courtillot 1 , C. Jublanc 2 , M. De Kerdanet 5 , J. Poirier 1 , L. Riffaud 6 , C. Sainte-Rose 7 , R. VanEffenterre 4 , G. Brassier 6 , F. Bonnet 1 & P. Touraine 1
1Hôpital Sud, Université Rennes 1, Rennes, France; 2Groupe Hospitalier Pitié-Salpêtrière, Pierre and Marie Curie University, Paris VI, Paris, France; 3Centre de Recherche du Centre Hospitalier de l’Université de Montreal, Montreal, Quebec, Canada; 4Groupe Hospitalier Pitié-Salpêtrière, Paris, France; 5Hôpital Sud, Université Rennes 1, Rennes, France; 6Hôpital Pontchaillou, Université Rennes 1, Rennes, France; 7Hôpital Necker, Université Paris Descartes, Paris, France.
Context: Craniopharyngiomas are often associated with an unfavorable prognosis but data on their long-term consequences are sparse.
Objective: To identify markers of recurrence and factors associated with compromised social rehabilitation and altered quality of life (QoL) in a large cohort of patients with either childhood onset (CO) or adult onset (AO) craniopharyngioma.
Methods: Retrospective analysis was performed for 171 patients treated for craniopharyngioma in two academic centers in France between 1972 and 2009. For each subject, data were collected concerning clinical presentation, imaging features, visual sequelae, endocrine and metabolic impact, treatment modalities (surgery, radiotherapy), recurrence-free survival rate and social insertion, as well as answers to the WHOQOL-BREF questionnaire.
Results: A total of 65 CO and 106 AO patients were reviewed. If CO was diagnosed before the age of 10 years, this was associated with a higher incidence of obesity, blindness and panhypopituitarism, and only 40.7% of subjects had adequate work or school attendance compared to 72.4% of patients with later disease onset. Initial symptoms of intracranial hypertension (SIHT), pterional surgery and multiple surgery were associated with obesity and poorer social insertion. No determinant of QoL was identified. In the subgroup of patients treated in the 90’s and later, the progression rate was 59.4% in patients with residual tumor on MRI and the recurrence rate was 19.8%. Recurrence/progression correlates significantly with male gender, early onset (before 10 years) and SIHT, but only SIHT at presentation remained a significant predictor with multivariate analysis.
Conclusions: Craniopharyngioma continues to be associated with severe outcomes. Higher morbidity rates are found in patients with early onset disease (before 10 years), initial SIHT or in whom pterional surgery was required. Markers of recurrence are difficult to identify, with SIHT being the most powerful predictor.
| <10 years | 10–18 years | P | >18 years | P (CO Vs AO) | |
| At least three anterior pituitary insufficiencies | 100% | 82.3% | 0.03 | 73.8% | 0.01 |
| Diabetes insipidus | 96.4% | 82.3% | 0.12 | 68.0% | <0.01 |
| Major visual acuity and field impairment | 53.8% | 50.0% | 0.77 | 48.0% | 0.66 |
| Blindness | 37.0% | 5.9% | <0.01 | 13.6% | 0.30 |
| Epilepsy | 32.1% | 18.7% | 0.23 | 15.5% | 0.14 |
| Median BMI | 33.1 | 26.2 | <0.01 | 27.7 | 0.80 |
| BMI >30 | 67.9% | 24.2% | 41.5% |
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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