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. A retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated was performed. 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 yr)] diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). 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 (ACP) and papillary CP (PCP) 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. 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.


中文翻译：

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老年人颅咽管瘤：西班牙的一项多中心和全国性研究

背景。颅咽管瘤（CP）是一种罕见的老年人肿瘤，其临床特征和预后在该人群中尚不清楚。目的。评价老年人诊断为CP的临床病理特征和治疗效果。患者和方法。对诊断为 65 岁以上并接受手术治疗的 CP 患者进行了一项回顾性、多中心、全国性研究。结果。从总共 384 名成人 CP 患者中，我们选择了 53 名 (13.8%) 患者 [27 名女性 (50.9%)，平均年龄 72.3 ± 5.1 岁（范围 65-83 岁）] 在 65 岁后诊断。最常见的临床症状是视野缺损（71.2%），其次是头痛（45.3%）。最大肿瘤直径为 2.9 ± 1.1 cm。在大多数患者中，肿瘤呈鞍上（96.2%）和混合（实性囊性）（58.5%）。最常用的手术方法是经颅手术（52.8%），超过一半的患者（54.7%）接受了次全切除术（STR）。精金 CP (ACP) 和乳头状 CP (PCP) 分别占 51% 和 45.1%，其余为混合型。手术伴随着视野缺损和头痛的改善；然而，垂体激素功能减退增加，主要是以尿崩症 (DI) 患病率增加为代价（从 3.9% 到 69.2%）。与次全切除相比，近全切除 (NTR) 的 DI 患病率更高（87.5% vs 53.6%，p=0.008）。患者随访 46.7±40.8 个月。死亡率为 39.6%，中位生存时间为 88 (95% CI, 57-118) 个月。最后一次就诊时的 DI 与较低的生存率相关。结论。在老年人中诊断出的 CP 显示出与年轻时诊断出的相似的性别分布和组织学形式。就诊时，视野改变和头痛是主要的临床症状，手术后可显着改善。然而，手术，主要是 NTR，伴随着垂体功能的恶化，尤其是 DI，这似乎是该人群死亡率的预测指标。