title: Tumour recurrence and enlargement in patients with craniopharyngioma with and without GH replacement therapy during more than 10 years of follow-up.
abstract: OBJECTIVE
  Most patients who have been treated for craniopharyngioma (CP) are GH deficient (GHD). GH replacement therapy (GHRT) may stimulate tumour regrowth; and one of the concerns with long-term GHRT is the risk of tumour progression. Therefore, the objective was to study tumour progression in CP patients on long-term GHRT.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  The criteria for inclusion of cases were: i) GHD caused by CP; ii) GHRT >3 years; and iii) regular imaging. This resulted in 56 patients (mean age at diagnosis 25±16 years) with a mean duration of GHRT of 13.6±5.0 years. As controls, 70 CP patients who had not received GHRT were sampled with regard to follow-up, gender, age at diagnosis and initial radiation therapy (RT).
  
  
  RESULTS
  The 10-year tumour progression-free survival rate (PFSR) for the entire population was 72%. There was an association (hazard ratio, P value) between PFSR and initial RT (0.13, 0.001) and residual tumour (3.2, 0.001). The 10-year PFSR was 88% for the GHRT group and 57% for the control group. Substitution with GHRT resulted in the following associations to PFSR: GHRT (0.57, 0.17), initial RT (0.16, <0.001), residual tumour (2.6, <0.01) and gender (0.57, 0.10). Adjusted for these factors, the 10-year PFSR was 85% for the GHRT group and 65% for the control group.
  
  
  CONCLUSIONS
  In patients with CP, the most important prognostic factors for the PFSR were initial RT and residual tumour after initial treatment. Long-term GHRT did not affect the PFSR in patients with CP.
authors.affiliation: Department of Endocrinology, Sahlgrenska University Hospital, Gröna Stråket 8, Gothenburg, Sweden. daniel.olsson@medic.gu.se
authors.forename: D S
authors.initials: DS
authors.lastname: Olsson
authors.forename: M
authors.initials: M
authors.lastname: Buchfelder
authors.forename: K
authors.initials: K
authors.lastname: Wiendieck
authors.forename: N
authors.initials: N
authors.lastname: Kremenevskaja
authors.forename: B-Å
authors.initials: BÅ
authors.lastname: Bengtsson
authors.forename: K-E
authors.initials: KE
authors.lastname: Jakobsson
authors.forename: M
authors.initials: M
authors.lastname: Jarfelt
authors.forename: G
authors.initials: G
authors.lastname: Johannsson
authors.forename: A G
authors.initials: AG
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003397:Craniopharyngioma / Q000139:chemically induced* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000009:adverse effects* / Q000172:deficiency; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced; D018365:Neoplasm, Residual / Q000473:pathology; D010911:Pituitary Neoplasms / Q000139:chemically induced* / Q000473:pathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone