Risk Factors for Tumor Residual and Recurrence in First-Time Resection of Craniopharyngioma through Endoscopic Endonasal Approach

Introduction: Craniopharyngiomas are benign tumors with aggressive biology. These tumors are increasingly resected via endoscopic endonasal surgery (EES). This study investigates risk factors for residual and recurrence for patients with craniopharyngiomas who underwent first time resection via EES.

Objective: To describe the risk factors for craniopharyngioma residual and recurrence after endoscopic endonasal resection as first-line treatment.

Method: Patients were included if they underwent EES for first-time resection of craniopharyngioma between 1999 and 2020. Group differences were assessed with Pearson's chi-squared test for categorical variables and t-test for continuous variables. Risk factors for residual were evaluated using uni- and multivariable logistic regression models. Risk factors for recurrence were assessed using Kaplan–Meier and Cox survival analysis.

Results: Ninety-two patients were included. Mean tumor volume was 13.08 cc (SD: 13.78). Fifty-two patients (56.5%) had tumor residual with patients operated before 2010 having lower GTR (23.7%) compared with those operated after 2010 (57.4%).The frequency of tumor residual by site was 66.6% in the middle cranial fossa, 44.9% third ventricle/hypothalamus, 40% anterior cranial fossa, and 37.8% in the optic apparatus. Risk factors for tumor residual on univariate analysis were male sex (p = 0.058) and initial surgery before 2010 (p = 0.002). In addition, the rate of any residual was higher in tumors spanning multiple anatomical sites (p = 0.096) and with larger tumor volume (p = 0.08). Only initial surgery before 2010 persisted as a statistically significant risk factor for residual on multivariate analysis (p = 0). Tumor residual at any anatomical site was strongly associated with tumor recurrence (p = 0.001), specially at the anterior (p < 0.05)and middle fossae (p < 0.05, stalk (p = 0.001), third ventricle/hypothalamus (p = 0.001), and optic apparatus (p = 0.0453). Similarly, tumors originally extending into the anterior (p = 0.001), middle (p < 0.05) and posterior cranial fossae (p = 0.01) had higher risk of recurrence. Univariate analysis showed increased risk of recurrence in tumors spanning multiple sites (p = 0.046) and larger tumors by volume (p = 0.075. On multivariate analysis patients operated before 2010 (p = 0.006) had higher risk of recurrence. Progression free survival was higher in surgeries performed after 2010 (42.5 months) versus before 2010 (18.5 months) due to difference in GTR. Younger age, tumor involvement in the third ventricle/hypothalamus, and larger tumors were associated with worsening post-operative anterior pituitary function (p = 0.001, p = 0.014, p = 0.018, respectively) and diabetes insipidus (p = 0.001, p = 0.015, p = 0.05 respectively) regardless of the surgical learning curve.

Conclusion: For patients undergoing EES for first-time craniopharyngioma resection, the main risk factors for tumor residual is surgeon experience. Similarly, the risk factors for tumor recurrence are surgeon experience, tumor involvement of the third ventricle/hypothalamus, and tumors originally extending beyond the parasellar region likely due to anatomical limitations. Post-operative panhypopituitarism is associated with younger age, larger tumors, and third ventricle/hypothalamic involvement.

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Artikel online veröffentlicht:
01. Februar 2023