Endocrine Abstracts

JOINT2718

Background: Craniopharyngioma is a rare non-malignant tumor of the suprasellar region associated with poor outcomes, particularly severe hypothalamic obesity. The aim of this retrospective study was to compare the outcome of patients treated in two specialized university hospitals (surgery & long-term care) with the overall outcome in Germany documented in the German Craniopharyngioma Registry. The primary endpoint was BMI at the last follow-up in pediatric care.

Methods: All patients with craniopharyngioma undergoing surgery between 2000 and 2020 were identified from two specialized pediatric centers (SC). Data from the German craniopharyngioma registry (REG), collected in the same period, served as a comparison. Age and BMI at surgery, number and type of surgeries, radiotherapy, and age and BMI at last follow-up were recorded. Patients with follow-up <12 months were excluded. Each BMI was calculated as a percentage of the P95 value corresponding to age and sex (%BMI_P95), a measure that correlates better with fat mass in severely obese children than SDS-LMS. Data are given as median and quartiles. The Mann-Whitney U test was applied for statistical analysis.

Results: A total of 54 SC and 187 REG patients were analyzed. The cohorts (SC vs REG) were comparable in terms of age (9.7 y (6.1-13.2) vs 10.5 y (7.2-13.7)), sex (43 vs 52% female), and %BMI_P95 (81.5 (70.0-92.2) vs 82.8 (71.8-96.1)) at surgery. Pre-treatment obesity (BMI >P97) was observed in 7.7% of SC patients compared to 11.7% in REG patients. Treatment modalities differed, with higher transsphenoidal surgery rates at SC (37.7 vs 19.3%) and lower radiotherapy rates at SC (31.5 vs 50.5%). Occurrence of relapse surgery (35.2 vs 32.0 %) and the number of relapses (mean of 0.54 vs 0.41) were comparable. The follow-up time was 7.8 y (5.3-10.5) in SC and 6.2 y (3.2-9.0) in REG, with last follow-up age of 18.6 y (15.5-20.2) in SC and 17.3 y (13.8-19.7) in REG. Height SDS at last follow-up was not different; -0,06 (-1,01 – 0.73) in SC and -0.05 (-0.89 – 0.79) in REG. In contrast, at last follow-up 37.0% of the patients were obese in SC, but 56.1 % in REG. Notably, %BMI_P95 was 92.8 (77.8-118.4) in SC, but 106.5 (89.6-130.8) in REG, with a significantly higher post-surgical increase of %BMI_P95 in REG (P = 0.024).

Conclusions: Data of this study clearly suggest that children with craniopharyngioma benefit significantly from treatment in specialized centers. The observed outcome speaks in favor of centralized care treatment.