Long-term outcomes in patients with adult-onset craniopharyngioma

Purpose Craniopharyngiomas are nonmalignant sellar and parasellar tumors exhibiting a bimodal age distribution. While the outcomes following treatment in patients with childhood-onset craniopharyngiomas are well characterized, similar information in adult-onset craniopharyngiomas is limited. We aimed to describe the long-term outcomes (weight and metabolic parameters, mortality) in patients with adult-onset craniopharyngioma following treatment. Methods Patients with adult-onset craniopharyngioma with initial treatment (1993-2017) and >6 months of follow-up at our institution were retrospectively identified. Body mass index (BMI) categories included obese (BMI >= 30 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and normal weight (BMI < 25 kg/m(2)). Results For the 91 patients with adult-onset craniopharyngioma (44% women, mean diagnosis age 48.2 +/- 18 years) over a mean follow-up of 100.3 +/- 69.5 months, weight at last follow-up was significantly higher than before surgery (mean difference 9.5 +/- 14.8 kg, P < 0.001) with a higher percentage increase in weight seen in those with lower preoperative BMI (normal weight (20.7 +/- 18%) vs. overweight (13.3 +/- 18.0%) vs. obese (6.4 +/- 15%), P = 0.012). At last follow-up, the prevalence of obesity (62 vs. 40.5%, P = 0.0042) and impaired glucose metabolism (17.4% vs. 34%, P = 0.017) increased significantly. All-cause mortality was 12%, with the average age of death 71.9 +/- 19.7 years (average U.S. life expectancy 77.7 years, CDC 2020). Conclusion Patients with adult-onset craniopharyngioma following treatment may experience weight gain, increased prevalence of obesity, impaired glucose metabolism, and early mortality. Lower preoperative BMI is associated with a greater percentage increase in postoperative weight.