Prognostic Factors and Treatment Impact on Overall Survival in Adult Craniopharyngioma

Abstract

This study aims to examine the demographics, tumor characteristics, treatments, and clinical outcomes of a large adult craniopharyngioma population. The 2004-2018 National Cancer Database was queried to investigate adult patients with craniopharyngioma. Univariable and multivariable Cox hazard ratio analysis was conducted to analyze the overall survival (OS) impact of demographic and clinical variables. A total of 666 adult craniopharyngioma patients were identified with a mean age of 51 (standard deviation 16). On multivariable analysis, independent of demographic and clinical variables, increased age, uninsured status, Medicaid, Medicare, Charlson-Deyo Comorbidity Index (CCI) of 2, and tumor size over 40 mm were independently associated with worse OS. There was no significant difference in survival between histological subtypes. Gross total resection (GTR) (HR .602, 95% CI .384-.942, p=.026) and subtotal resection (STR) with adjuvant radiotherapy (HR .316, 95% CI .140-.710, p=.005) were independently associated with improved OS. GTR with radiotherapy trended towards improved OS (HR .601, 95% CI .334-1.083, p =0.090), but STR alone and radiotherapy alone demonstrated no significant difference in survival compared to no treatment on multivariable analysis. Kaplan-Meier survival models demonstrated improved survival with GTR, GTR + RT, and STR +RT. Patients undergoing endoscopic resection had significantly lower GTR rates and higher rates of adjuvant radiotherapy compared to open approaches, but no difference in overall survival. Adult craniopharyngioma patients that underwent GTR or STR with adjuvant radiotherapy had significantly improved overall survival. Endoscopic approaches had lower rates of GTR but no difference in overall survival.