Introduction: Craniopharyngiomas (CP) often pose a surgical challenge due to their tumor extension and growth potential. However, factors influencing extent of resection (EOR) and overall survival (OS) in patients with giant CP tumors remain unclear.
Methods: Patients diagnosed with CP between 2000 and 2021 were identified from the SEER 17 Registries using ICD-O-3 codes 9250-9252. Giant CP was defined as a tumor measuring 40 mm or larger. A multivariable logistic regression model evaluated factors associated with EOR, while a Cox proportional hazards model assessed variables related to OS. Results are reported as median [IQR], OR [95% CI], and HR [95% CI].
Results: Among 2,902 CP patients, median age was 43 years [IQR 16−53], 37% were adults, 46% were female, 67% were White, 33% were Hispanic, and 1,182 (41%) had giant CPs. Gross total resection (GTR) rates did not differ significantly by tumor size (13% for both < 40mm and ≥40mm; p=0.236), however, GTR rates declined over time (21% in 2002-2008 vs. 11% in 2018-2021; p< 0.05). Adults (OR 0.74 [0.64-0.87]; p< 0.05) and females (OR 0.84 [0.74-0.96]; p< 0.05) were less likely to undergo extensive resection, while larger tumor size did not affect EOR (OR 0.89 [0.77-1.02]; p=0.09). In patients with giant CP, GTR did not significantly impact survival (HR 0.93 [0.62-1.40]; p=0.475), whereas radiotherapy was associated with improved survival (HR 0.69 [0.49-0.97]; p< 0.05).
Conclusion : Findings suggest a shift toward less aggressive surgery for CP, particularly in giant tumors, with adjuvant radiotherapy demonstrating a survival benefit. These insights highlight evolving treatment paradigms for managing large CP tumors.
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