Craniopharyngioma in the Elderly: A Multicenter and Nationwide Study in Spain
Por:
Iglesias, P, Nocete, I, Rodriguez, MDM, Venegas-Moreno, E, Ares, J, Biagetti, B, Berrocal, VR, Guerrero-Perez, F, Vicente, A, Villar-Taibo, R, Cordido, F, Paja, M, Glerean, M, Rivera, NG, Fuentes, ED, Blanco, C, Alvarez-Escola, C, Martin, T, Webb, SM, Bernabeu, I, Villabona, C, Soto-Moreno, A, Gaztambide, S, Diez, JJ
Publicada:
1 sep 2021
Resumen:
Background: Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. Aim: To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. Patients and Methods: This was a retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated. Results: From a total of 384 adult CP patients, we selected 53 (13.8%) patients (27 women [50.9%], mean age 72.3 +/- 5.1 years [range 65-83 years]) diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). The maximum tumor diameter was 2.9 +/- 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%), and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP and papillary CP were present in 51 and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9 to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs. 53.6%, p = 0.008). Patients were followed for 46.7 +/- 40.8 months. The mortality rate was 39.6% with a median survival time of 88 (95% CI: 57-118) months. DI at last visit was associated with a lower survival. Conclusion: CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation, visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.
Filiaciones:
Iglesias, P:
Hosp Univ Puerta de Hierro Majadahonda, Inst Invest Sanitaria Puerta de Hierro Segovia Ar, Dept Endocrinol, Madrid, Spain
Nocete, I:
Hosp Univ Puerta de Hierro Majadahonda, Inst Invest Sanitaria Puerta de Hierro Segovia Ar, Dept Endocrinol, Madrid, Spain
Rodriguez, MDM:
Hosp Univ Cruces, Dept Endocrinol, Biocruces Bizkaia, EndoERN,Cruces Barakaldo, Bizkaia, Barakaldo, Spain
Venegas-Moreno, E:
Hosp Univ Virgen del Rocio, Dept Endocrinol, Seville, Spain
Ares, J:
Hosp Univ Cent Asturias, Dept Endocrinol, Oviedo, Spain
Biagetti, B:
Univ Vall dHebron, Dept Endocrinol, Barcelona, Spain
Berrocal, VR:
Hosp Univ Ramon y Cajal, Dept Neurosurg, Madrid, Spain
Guerrero-Perez, F:
Hosp Bellvitge Princeps Espanya, Dept Endocrinol, Barcelona, Spain
Vicente, A:
Hosp Virgen de la Salud, Dept Endocrinol, Toledo, Spain
Villar-Taibo, R:
Complexo Hosp Univ Santiago de Compostela, Dept Endocrinol, Santiago De Compostela, Spain
Cordido, F:
Complejo Hosp Univ A Coruna, Dept Endocrinol, La Coruna, Spain
Univ A Coruna, Fac Ciencias Salud, La Coruna, Spain
Paja, M:
Hosp Univ Basurto, Dept Endocrinol, Bilbao, Spain
Glerean, M:
Hosp Italian Buenos Aires, Dept Endocrinol, Buenos Aires, DF, Argentina
Univ Autonoma Barcelona, Dept Endocrinol,Unidad 747,ISCIII, Hosp St Pau,Ctr Invest Biomed Red Enfermedades Ra, Dept Med Endocrinol,IIB St Pau,Res Ctr Pituitary, Barcelona, Spain
Rivera, NG:
Hosp Univ Virgen de la Macarena, Dept Endocrinol, Seville, Spain
Fuentes, ED:
Hosp Univ Virgen del Rocio, Dept Endocrinol, Seville, Spain
Blanco, C:
Hosp Univ Principe Asturias, Dept Endocrinol, Madrid, Spain
Alvarez-Escola, C:
Hosp Univ La Paz, Dept Endocrinol, Madrid, Spain
Martin, T:
Hosp Univ Virgen de la Macarena, Dept Endocrinol, Seville, Spain
Webb, SM:
Univ Autonoma Barcelona, Dept Endocrinol,Unidad 747,ISCIII, Hosp St Pau,Ctr Invest Biomed Red Enfermedades Ra, Dept Med Endocrinol,IIB St Pau,Res Ctr Pituitary, Barcelona, Spain
Bernabeu, I:
Complexo Hosp Univ Santiago de Compostela, Dept Endocrinol, Santiago De Compostela, Spain
Villabona, C:
Hosp Bellvitge Princeps Espanya, Dept Endocrinol, Barcelona, Spain
Soto-Moreno, A:
Hosp Univ Virgen del Rocio, Dept Endocrinol, Seville, Spain
Gaztambide, S:
Hosp Univ Cruces, Dept Endocrinol, Biocruces Bizkaia, EndoERN,Cruces Barakaldo, Bizkaia, Barakaldo, Spain
Univ Basque Country, CIBERER, CIBERDEM, Baracaldo, Spain
Diez, JJ:
Hosp Univ Puerta de Hierro Majadahonda, Inst Invest Sanitaria Puerta de Hierro Segovia Ar, Dept Endocrinol, Madrid, Spain
Univ Autonoma Madrid, Dept Med, Madrid, Spain
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