P14.09.B RISK FACTORS FOR CRANIOPHARYNGIOMA RECURRENCE: ANAYLSIS OF LONG-TERM FOLLOW-UP

Abstract BACKGROUND Craniopharyngiomas are benign tumors that often exhibit aggressive clinical behavior. The aim of this study is to evaluate the long-term outcomes of surgery for primary and recurrent craniopharyngiomas, identify the risk factors for recurrence and assess the predictors of subtotal resection (STR). MATERIAL AND METHODS We retrospectively analyzed data from 279 craniopharyngioma surgeries performed at a single institution between 2010 and 2024. The median follow-up period was 64.0 (IQR 30.5-100.5) months. Preoperative characteristics, neuro-endocrinological results, recurrence patterns, and radiological features were evaluated. Statistical analyses included Kaplan-Meier survival analysis, Cox regression for recurrence factors, and logistic regression for predictors of the extent of resection. RESULTS The cohort included 185 primary and 94 recurrent tumors, and the endoscopic endonasal approach was used in 84.2% of cases. The overall 5-year recurrence rate was 29.2% (95% CI: 23.4-36.0%). Gross total resection (GTR) was achieved in 85.7% of cases. Multivariate analysis revealed that pediatric-onset (HR 1.98, 95% CI: 1.12-3.50) and subtotal resection (HR 3.40, 95% CI: 1.79-6.42) were significant risk factors for recurrence. Multiple recurrences showed progressive patterns of decreasing gross total resection rates and shorter recurrence intervals. Vascular encasement (OR 8.03, 95% CI 3.23-19.9) and recurrent tumor status (OR 5.10, 95% CI: 2.25-11.6) were significant predictors of STR. CONCLUSION Age at onset and extent of resection are critical factors influencing craniopharyngioma recurrence. Radiological features, particularly vascular encasement, are valuable predictors of the likelihood of subtotal resection. These findings offer important insights for planning the optimal treatment strategy for craniopharyngioma patients.