POSTOPERATIVE PROGNOSIS IN CRANIOPHARYNGIOMA WITH RESPECT TO CARDIOVASCULAR MORTALITY, SURVIVAL, AND TUMOR RECURRENCE

Specific causes of death, survival, and recurrence rates were assessed in a cohort of 60 patients who had undergone surgery for craniopharyn gioma between 1951 and 1988. Compared to the general population, the s tandardized mortality ratio (SMR) was increased [5.55; 95% confidence interval (CI), 3.68-8.22], and it was higher among females (SMR, 11.4) than males (SMR, 4.79). The risk of cardio- and cerebrovascular morta lity (SMR, 3.21; 95% CI, 1.29-6.61) was also enhanced. The cumulative survival rates 10 and 15 yr after the initial operation were 68% (95% CI 54-78) and 59% (95% CI 30-63), respectively. A multivariate surviva l analysis adjusting for age showed a protective effect of radiotherap y (hazard ratio, 0.3; 95% CI, 0.1-0.8) and an increased risk of death after recurrence (hazard ratio, 4.4; 95% CI, 1.4-14), but no obvious e ffect of radicality at surgery. However, when patients who had died wi thin 6 months after surgery were excluded, no significant protective e ffect of radiotherapy remained. The cumulative frequency of recurrence after 10 yr was 33% (95% CI, 22-48%), and that after 15 yr was 40% (9 5% CI, 28-56%). The incidence of recurrence did not differ significant ly with respect to age, radicality at surgery, or postoperative radiot herapy. The determinants for long term outcome in patients with cranio pharyngioma are interrelated in a complex way, which calls for strict selection criteria in follow-up studies and the use of multivariate st atistical models.