Risk factors for recurrence in pediatric craniopharyngioma: impact of extensive tumor involvement and growth hormone therapy in a multicenter cohort

Abstract

Purpose: Craniopharyngioma is a benign sellar tumor that accounts for 4%-9% of pediatric intracranial tumors and is associated with substantial endocrine morbidity.It has a high recurrence rate, and several predictors have been reported; however, these risk factors have not been fully consistent across studies.This study evaluated clinically relevant risk factors for recurrence in pediatric craniopharyngioma using a multicenter cohort.Methods: This retrospective study included patients diagnosed with craniopharyngioma before 18 years of age at 10 institutions in Korea.Clinical characteristics, magnetic resonance imaging (MRI) findings at diagnosis, postoperative hormonal test results, and growth hormone treatment (GHT) were evaluated.Results: A total of 254 patients were analyzed.The median age at diagnosis was 8.21 years (IQR, 5.20-11.28),and the median follow-up duration was 11.22 years (6.32-16.60).Tumor recurrence occurred in 66 patients (26.0%) after a median of 3.12 years (2.17-5.08).Among these patients, 45 experienced one recurrence, 15 experienced two recurrences, four experienced three recurrences, and two experienced five recurrences.In multivariate analysis, extensive tumor involvement on MRI at diagnosis-defined as involvement of the sphenoid sinus, frontal base, or brainstem-was significantly associated with recurrence (hazard ratio=6.16,p=0.038).Postoperative GHT was not significantly associated with recurrence (p=0.671).Conclusion: Extensive radiologic tumor involvement at diagnosis may be a predictor of recurrence in pediatric craniopharyngioma, whereas postoperative GHT was not associated with an increased risk of recurrence.These real-world findings highlight the importance of careful surveillance in patients with extensive tumor involvement and may help guide clinical decision-making regarding GHT.

The authors' abstract, as published at the source. Annals of Pediatric Endocrinology & Metabolism, 2026 · DOI ↗