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

Abstract

BackgroundCraniopharyngiomas 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 in uence of facility volume and type on treatment modalities, extent of surgery and survival of craniopharyngioma. MethodsThe 2004-2016 National Cancer Database (NCDB) was queried for patients diagnosed with craniopharyngioma. Facilities were classi ed by type (academic vs. non-academic) and low-(LVC, treating < 8 patients over the timeline) versus high-volume (HVC, treating ≥ 8 patients over the timeline).Differences in treatment course, outcomes, and OS by facility type were assessed. Results3730 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 signi cantly 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]). ConclusionTreatment 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.

Clinical Productivity and Patient Complexity of Academic Rhinologists: An Analysis of Medicare Metrics

“…[25][26][27][28][29][30][31][32][33] Additionally, recent literature indicates improved outcomes for patients with complex rhinologic diseases treated at these centers. [33][34][35][36][37][38][39][40][41] While non-ranked faculty performed a high volume of procedures, they likely refer the most complex patients to academic centers. 6,[42][43][44] Importantly, although risk implies complexity, 45 it may not always mean clinically challenging.…”

Comparison of MRI findings of hypothalamic-optic chiasmatic gliomas and craniopharyngiomas

“…In addition, HOCGs in adults are mostly high-grade malignant gliomas with a poor prognosis (17). Craniopharyngiomas are benign tumors with high overall survival (OS) with 5-year OS rates >80% in adults and >95% in children (18). Although malignant transformation and distant metastases of craniopharyngiomas are extremely rare, these lesions have a high recurrence rate (20%-40%) leading to long-term morbidity (19)(20)(21).…”