PMON151 Long-Term Outcomes in Patients With Adult-Onset Craniopharyngioma
Authors: Dogra Prerna , Bedatsova Lucia , Giannini Caterina , Gompel Jamie Van , Donegan Diane , Erickson Dana 
Published: November 2022

Introduction

Craniopharyngiomas are nonmalignant sellar/parasellar epithelial tumors exhibiting a bimodal age distribution. While the outcomes following the treatment of patients with childhood-onset craniopharyngiomas are well characterized, similar information in adult-onset craniopharyngiomas (AOC) is limited. We aimed to describe the long-term outcomes related to weight changes, obesity prevalence, metabolic comorbidities, and all-cause mortality in patients with AOC following treatment.

Methods

We identified all adults with a newly diagnosed craniopharyngioma who had initial neurosurgical treatment (1993 -2017) and &gt; 6 months of follow-up at our institution. Medical records were reviewed for demographics, anthropometric measurements, biochemical, radiological, pathological investigations, treatment course, and outcomes. Based on body mass index (BMI), patients were categorized as obese (BMI &gt;30 Kg/m2), overweight (BMI 25-29.9 Kg/m2), and normal weight (BMI &lt; 25 Kg/m2).

Results

For the 91 patients with AOC, the mean age at diagnosis was 48.2±18 years, and 44% were women. Over a mean follow-up duration of 100.3±69.5 months, weight was significantly higher at last follow-up than before surgery (mean difference 9.4 ±14.8 kg, P= &lt;0.001), with 65% of patients experiencing &gt;5% weight gain. Postoperative weight gain of &gt;5% was not associated with preoperative BMI; however, those with lower preoperative BMI experienced a higher mean percentage change in weight [normal weight (20.7 +18%) vs. overweight (13.3+18.0%) vs. obese (6.4+15%), P=0.012]. The prevalence of obesity increased significantly by the last follow-up than before the initial treatment (62 vs. 40.5%, P=0.0042). Weight gain of &gt;5% and obesity by the last follow-up were not associated with gender, tumor size, histological subtype, the extent of resection, radiotherapy, postoperative grade of hypothalamic injury, type or number of pituitary hormone deficiencies, including diabetes insipidus.

On follow-up, the proportion of patients who developed hypertension (28 vs. 40% P=0.09) or dyslipidemia (30 vs. 43%, P= 0.06) increased, but this difference was not statistically significant. Whereas the proportion with impaired glucose metabolism (impaired glucose tolerance, impaired fasting glucose, or diabetes mellitus) was significantly increased on follow-up (17.4% vs. 34%, P= 0.017). In a small subset of patients with abdominal imaging, 52% had radiographic evidence of fatty liver disease. At last follow-up, mortality was 12%, with the average age of death 71.9±19.7 years. There was no difference in survival based on BMI &gt;30 kg/m2, ≥3 anterior pituitary hormone deficiencies, diabetes insipidus, the extent of resection, or radiotherapy use.

Conclusion

Patients treated for AOC experience significant long-term consequences of weight gain, obesity, impaired glucose metabolism, and earlier mortality. The mean percentage increase in weight is inversely proportional to the preoperative BMI. The average age of death (71.9 years) for patients with AOC is lower than the average life expectancy in the US (77.7 years, CDC 2020).

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.