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. Design: Case-control study. Patients and methods:The criteria for inclusion of cases were: i) GHD caused by CP; ii) GHRT O3 years; and iii) regular imaging. This resulted in 56 patients (mean age at diagnosis 25G16 years) with a mean duration of GHRT of 13.6G5.0 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.

Growth hormone replacement therapy reduces risk of cancer in adult with growth hormone deficiency: A meta-analysis

“…But a period of 5 years may not have been long enough to verify this influence on recurrence potential [21]. In parallel with these above study, the latter study found unrelated results [12]. On the contrary, our results even found that growth hormone therapy is associated with a decreased risk of the whole group.…”

“…After screening the titles and abstracts, 1431 records were excluded for various reasons (case reports, review, not human study, gene study, unexpected outcomes). Finally, 2retrospective studies and 7 prospective studies were included in the final analysis (see more details in Figure 1) [12–14, 16–21]. …”

“…However, a report with 5-year follow-up found that children with GHRT have a higher risk of neoplasms compared with non GHRT. Some studies showed an increased cancer risk [12–14], but others not [15, 16]. The results whether GHRT increased the cancer risk in AGHD patients still remain unclear.…”

Efficacy and safety of growth hormone treatment in adults with growth hormone deficiency: a systematic review of studies on morbidity

“…63 The systematic literature search on malignancies and regrowth or recurrence in adult patients with GHD on GH treatment revealed 14 studies. Nine of these studies looked at regrowth or recurrence of (peri)pituitary tumours, mostly based on brain imaging (Table 3A), 29,33,[64][65][66][67][68][69][70] and six investigated all malignancies or malignancy as cause of death in mixed aetiologies of GHD (Table 3B). 23,[28][29][30][31]71 One study looked at both outcomes.…”

“…more years of observation time. 64,65,67 Most of the studies compared data with patients with the same aetiology of GHD but without GH treatment. However, population sizes were limited.…”