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The impact of facility type and volume on treatment and overall survival in craniopharyngioma

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Abstract

Background

Craniopharyngiomas are uncommon benign sellar and parasellar tumors with high overall survival (OS) and recurrence rates. Treatment is often surgical but may include adjuvant therapies. The impact of adjuvant therapy and surgical approach have been evaluated, however, facility volume and type have not. The purpose of this study is to analyze the influence of facility volume and type on treatment modalities, extent of surgery and survival of craniopharyngioma.

Methods

The 2004–2016 National Cancer Database (NCDB) was queried for patients diagnosed with craniopharyngioma. Facilities were classified by type (academic vs. non-academic) and low-volume center (LVC) (Treating < 8 patients over the timeline) versus high-volume center (HVC), (Treating ≥ 8 patients over the timeline). Differences in treatment course, outcomes, and OS by facility type were assessed.

Results

3730 patients (51.3% female) with mean age 41.2 ± 22.0 were included with a 5-year estimated OS of 94.8% (94.0–95.5%). 2564 (68.7%) patients were treated at HVC, of which 2142 (83.5%) were treated at academic facilities. Patients treated at HVC’s were more likely to undergo both surgery and radiation. Surgical approach at HVC was more likely to be endoscopic. Patients treated at HVC demonstrated significantly higher 5-year OS compared to patients treated at LVC (96% [95% CI 95.6–97.1% versus 91.2% [95% CI 89–92.7%] with lower risk of mortality (Hazard ratio [95% CI] = 0.69 [0.56–0.84]).

Conclusion

Treatment of craniopharyngioma at HVC compared to LVC is associated with improved OS, lower 30- and 90-day postoperative mortality risk, and more common use of both radiotherapy and endoscopic surgical approach.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA

    Benjamin F. Bitner, Derek H. Liu, Madeline M. Nottoli, Sina J. Torabi & Edward C. Kuan

  2. Department of Neurological Surgery, University of California Irvine Medical Center, Orange, CA, USA

    Frank P. K. Hsu & Edward C. Kuan

  3. Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA

    Madeline M. Nottoli

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Contributions

BFB: Conceptualization, methodology, writing—original drafting, writing—review & editing, approval of final version. DHL: Conceptualization, methodology, statistical analysis, writing—original drafting, writing—review & editing, approval of final version. MMN: Conceptualization, writing—original drafting, writing—review & editing, approval of final version. SJT: Conceptualization, methodology, writing—original drafting, writing—review & editing, approval of final version. FPKH: Scientificc advisor, approval of final version. ECK: Conceptualization, methodology, writing—original drafting, writing—review & editing, supervision, approval of final version.

Corresponding author

Correspondence to Edward C. Kuan.

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The authors have no conflicts of interest to declare that are relevant to this article.

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The study was exempt from review by the University of California, Irvine Institutional Review Board given the publicly available, de-identified nature of the NCDB.

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A portion of this work was presented as a podium presentation for the North American Skull Base Society at the NASBS 31st Annual Meeting, February 19, 2022.

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Bitner, B.F., Liu, D.H., Nottoli, M.M. et al. The impact of facility type and volume on treatment and overall survival in craniopharyngioma. Pituitary 26, 686–695 (2023). https://doi.org/10.1007/s11102-023-01359-8

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