Survival, hypothalamic obesity, and neuropsychological/psychosocial status after childhood-onset craniopharyngioma: newly reported long-term outcomes

Abstract

Background: Quality of life (QoL) and long-term prognosis are frequently, and often severely, impaired in craniopharyngioma (CP) patients. Knowledge of risk factors for long-term outcome is important for optimization of treatment.

Methods: Overall survival (OS) and progression-free survival (PFS), body mass index (BMI), neuropsychological status (EORTCQLQ-C30, MFI-20), and psychosocial status were analyzed in 261 patients with childhood-onset CP diagnosed before 2000 and longitudinally observed in HIT-Endo.

Results: Twenty-year OS was lower (P = .006) in CP with hypothalamic involvement (HI) (n = 132; 0.84 ± 0.04) when compared with CP without HI (n = 82; 0.95 ± 0.04). OS was not related to degree of resection, sex, age at diagnosis, or year of diagnosis (before/after 1990). PFS (n = 168; 0.58 ± 0.05) was lower in younger patients (<5 y at diagnosis) (n = 30; 0.39 ± 0.10) compared with patients aged 5-10 years (n = 66; 0.52 ± 0.08) and older than 10 years (n = 72; 0.77 ± 0.06) at diagnosis. PFS was not associated with HI, degree of resection, or sex. HI led to severe weight gain during the first 8-12 years of follow-up (median BMI increase: +4.59SD) compared with no HI (median increase: +1.20SD) (P = .00). During >12 years of follow-up, patients with HI presented no further increase in BMI. QoL in CP patients with HI was impaired by obesity, physical fatigue, reduced motivation, dyspnea, diarrhea, and nonoptimal psychosocial development.

Conclusions: OS and QoL are impaired by HI in long-term survivors of CP. HI is associated with severe obesity, which plateaus after 12 years. OS/PFS are not related to degree of resection, but gross-total resection should be avoided in cases of HI to prevent further hypothalamic damage, which exacerbates sequelae.

Keywords: craniopharyngioma; hypothalamus; obesity; pediatrics; quality of life.

Fig. 1.

Twenty-year overall survival (A) and 20-year progression-free survival (PFS) (E) of patients with childhood-onset craniopharyngioma recruited in HIT Endo. (B) depicts 20-year overall survival. (C) depicts 20-year overall survival. (D) depicts 20-year overall survival. (F) 20-year PFS related to the degree of surgical resection (CR = complete resection; IR = incomplete resection; as confirmed by neuroradiological reference assessment). (G) 20-year PFS related to hypothalamic involvement (HI). (H) 20-year PFS related to irradiation (XRT). Progression events before and after XRT are included in the analysis.

Fig. 1.

Twenty-year overall survival (A) and 20-year progression-free survival (PFS) (E) of patients with childhood-onset craniopharyngioma recruited in HIT Endo. (B) depicts 20-year overall survival. (C) depicts 20-year overall survival. (D) depicts 20-year overall survival. (F) 20-year PFS related to the degree of surgical resection (CR = complete resection; IR = incomplete resection; as confirmed by neuroradiological reference assessment). (G) 20-year PFS related to hypothalamic involvement (HI). (H) 20-year PFS related to irradiation (XRT). Progression events before and after XRT are included in the analysis.

Fig. 2.

Weight development in childhood-onset craniopharyngioma patients recruited in HIT Endo according to hypothalamic involvement. Body mass index (BMI) SDS is shown at time of diagnosis and at 2 intervals after diagnosis (8–12 years and more than 12 years). White boxes: BMI at diagnosis; grey: 8–12 year follow-up; black: more than 12 year follow-up. The horizontal line in the middle of the box depicts the median. The top and bottom edges of the box respectively mark the 25th and 75th percentiles. Whiskers indicate the range of values that fall within 1.5 box-lengths.

Fig. 3.

EORTC QLQ-C30 functioning domains (A) and symptom scales (B) and MFI-20 fatigue domains (C) in childhood-onset craniopharyngioma patients (recruited in HIT Endo) according to hypothalamic involvement. White boxes: patients without hypothalamic involvement. Black boxes: patients with hypothalamic involvement. The horizontal line in the middle of the box depicts the median. The top and bottom edges of the box respectively mark the 25th and 75th percentiles. Whiskers indicate the range of values that fall within 1.5 box-lengths.