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Physiologic Growth Hormone-Replacement Therapy and Craniopharyngioma Recurrence in Pediatric Patients: A
Nawaf M Alotaibi1, Nadia Noormohamed1, David J Cote2
1Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts, USA.
Insights
Growth hormone-replacement therapy (GHRT) significantly reduces craniopharyngioma recurrence in children post-surgery. This meta-analysis found lower recurrence rates in GHRT-treated patients compared to untreated ones.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Neurosurgery
Background:
- Craniopharyngioma is a common pediatric brain tumor.
- Recurrence remains a significant challenge after surgical resection.
- Growth hormone deficiency is frequent post-treatment.
Purpose of the Study:
- To systematically review and meta-analyze the impact of growth hormone-replacement therapy (GHRT) on craniopharyngioma recurrence in children.
- To assess the safety and efficacy of GHRT in preventing tumor regrowth.
Main Methods:
- Systematic search of PubMed, Embase, and Cochrane databases up to April 2017.
- Inclusion of ten studies (3487 patients) comprising retrospective cohorts and case series.
- Pooled effect estimates calculated using fixed- and random-effects models to analyze recurrence rates.
Main Results:
- Craniopharyngioma recurrence rate was significantly lower in children receiving GHRT (10.9%) compared to those not receiving it (35.2%).
- Subgroup analyses indicated higher recurrence in studies outside the US, single-center studies, and those with lower quality.
- No significant publication bias was detected (Begg's test P=0.7, Egger's test P=0.06).
Conclusions:
- GHRT is associated with a reduced rate of craniopharyngioma recurrence in pediatric patients.
- Further research may be needed to explore factors influencing recurrence in specific study settings.
Objective:
A systematic review and meta-analysis were conducted to examine the effect of growth hormone-replacement therapy (GHRT) on the recurrence of craniopharyngioma in children.
Methods:
PubMed, Embase, and Cochrane databases were searched through April 2017 for studies that evaluated the effect of GHRT on the recurrence of pediatric craniopharyngioma. Pooled effect estimates were calculated with fixed- and random-effects models.
Results:
Ten studies (n = 3487 patients) met all inclusion criteria, including 2 retrospective cohorts and 8 case series. Overall, 3436 pediatric patients were treated with GHRT after surgery and 51 were not. Using the fixed effect model, we found that the overall craniopharyngioma recurrence rate was lower among children who were treated by GHRT (10.9%; 95% confidence interval 9.80%-12.1%; I2 = 89.1%; P for heterogeneity <0.01; n = 10 groups) compared with those who were not (35.2%; 95% confidence interval 23.1%-49.6%; I2 = 61.7%; P for heterogeneity = 0.11; n = 3); the P value comparing the 2 groups was <0.01. Among patients who were treated with GHRT, subgroup analysis revealed that there was a greater prevalence of craniopharyngioma recurrence among studies conducted outside the United States (P < 0.01), single-center studies (P < 0.01), lower impact factor studies (P = 0.03), or studies with a lower quality rating (P = 0.01). Using the random-effects model, we found that the results were not materially different except for when stratifying by GHRT, impact factor, or study quality; this led to nonsignificant differences. Both Begg's rank correlation test (P = 0.7) and Egger's linear regression test (P = 0.06) indicated no publication bias.
Conclusions:
This meta-analysis demonstrated a lower recurrence rate of craniopharyngioma among children treated with GHRT than those who were not.
