Excess mortality after craniopharyngioma treatment: are we making progress?
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Craniopharyngioma is associated with an increased risk of mortality even after surgical, radiotherapeutic and hormone supplementations. Previous studies using different designs showed a possible trend of decreasing mortality in recent years. This review summarises studies reporting standardised mortality ratio (SMR) after craniopharyngioma treatment, as well as the bias and confounding in these studies to plan further researches.
PubMed and Embase was searched for manuscripts published before October 2018 using medical subject heading terms (“craniopharyngioma” or “hypopituitarism” and “mortality”).
Eight studies reported SMR after craniopharyngioma treatment, with a total of 2802 patients. The subgroup meta-analysis using random effects model was conducted to pool the SMR, which was 6.2 (95% CI 4.1–9.4) before 2010 and 2.9 (95% CI 2.2–3.8) after 2010 (subgroup test p < 0.01), respectively. Misclassification (one study) and selection bias (six studies) either inflated or deflated the result. The trend of increasing survival rate over the time was observed in studies without reporting SMR. Female patients, childhood-onset disease, hydrocephalus, tumour recurrence, body mass index and panhypopituitarism were identified as the important risk factors for excess mortality.
Though bias and confounding existed across studies, the decreasing SMR and increasing survival rate over the time was in favour of a real signal. It is necessary to launch studies to further investigate the morality and risk factors after multidisciplinary treatment of craniopharyngioma in a hospital-based manner, using the modern statistical method to adjust for bias and confounding.
KeywordsCraniopharyngioma Mortality Survival Hypopituitarism
Compliance with ethical standards
Conflict of interest
The author declares that he has no conflict of interest.
- 4.L.Z. Leng, J.P. Greenfield, M.M. Souweidane, V.K. Anand, T.H. Schwartz, Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 70(1), 110–23 (2012). https://doi.org/10.1227/NEU.0b013e31822e8ffc. discussion123–4CrossRefPubMedGoogle Scholar
- 8.C. van Bunderen, I. van Nieuwpoort, L. Arwert et al. Does growth hormone replacement therapy reduce mortality in adults with growth hormone deficiency? Data from the Dutch national registry of growth hormone treatment in adults. J. Clin. Endocrinol. Metab. 96(10), 3151–3159 (2011). https://doi.org/10.1210/jc.2011-1215 CrossRefPubMedGoogle Scholar
- 17.B. Bülow, R. Attewell, L. Hagmar, P. Malmström, C.H. Nordström, E.M. Erfurth, Postoperative prognosis in craniopharyngioma with respect to cardiovascular mortality, survival, and tumor recurrence. J. Clin. Endocrinol. Metab. 83(11), 3897–3904 (1998). https://doi.org/10.1210/jcem.83.11.5240 CrossRefPubMedGoogle Scholar
- 20.R.K. Crowley, O.P. Hamnvik, E.P. O’Sullivan et al. Morbidity and Mortality in Craniopharyngioma Patients after Surgery. Clin. Endocrinol. 2010:no–no. https://doi.org/10.1111/j.1365-2265.2010.03838.x.
- 21.C.C. van Bunderen, I.C. van Nieuwpoort, L.I. Arwert et al. Does Growth Hormone Replacement Therapy Reduce Mortality in Adults with Growth Hormone Deficiency? Data from the Dutch National Registry of Growth Hormone Treatment in Adults. J. Clin. Endocrinol. Metab. 96(10), 3151–3159 (2011). https://doi.org/10.1210/jc.2011-1215 CrossRefPubMedGoogle Scholar
- 22.D.S. Olsson, E. Andersson, I.-L. Bryngelsson, A.G. Nilsson, G. Johannsson, Excess Mortality and Morbidity in Patients with Craniopharyngioma, Especially in Patients with Childhood Onset: A Population-Based Study in Sweden. J. Clin. Endocrinol. Metab. 100(2), 467–474 (2015). https://doi.org/10.1210/jc.2014-3525 CrossRefPubMedGoogle Scholar
- 48.A.S. Sterkenburg, A. Hoffmann, U. Gebhardt, M. Warmuth-Metz, A.M.M. Daubenbüchel, H.L. Müller, Survival, hypothalamic obesity, and neuropsychological/psychosocial status after childhood-onset craniopharyngioma: newly reported long-term outcomes. Neuro. Oncol. 17(7), 1029–1038 (2015). https://doi.org/10.1093/neuonc/nov044 CrossRefPubMedPubMedCentralGoogle Scholar