Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
Otol Neurotol. 2020 Oct;41(9):e1149-e1153. doi: 10.1097/MAO.0000000000002756.
Definitive treatment of sporadic vestibular schwannoma (VS) following documented growth is common practice at most centers in the United States. However, as a natural extension of this paradigm, very little evidence exists surrounding the natural history of growing tumors. The primary objective of the current work was to describe the natural history of sporadic VS following documentation of initial tumor growth.
Retrospective cohort study.
Tertiary referral center.
Patients diagnosed with sporadic VS between January 1, 2001 and December 31, 2015 who elected continued observation despite having volumetric growth ≥20% of original tumor volume on interval magnetic resonance imaging (MRI).
Survival free of subsequent volumetric growth.
Of 361 patients undergoing observation with serial imaging during the study period, 85 patients met inclusion criteria at a median age of 66 years (interquartile ranges [IQR] 55-71). Within this cohort, 40 patients demonstrated subsequent volumetric growth at a median of 1.7 years (IQR 1.0-2.6) from the date of initial MRI that documented growth. The median volumetric growth was 43% (IQR 28-57), and the median growth rate was 0.026 cm per year (IQR 0.009-0.107). Survival free of subsequent volumetric growth rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years were 93% (87-99; 75), 67% (58-79; 45), 54% (43-67; 29), 44% (33-59; 19), and 41% (30-56; 12), respectively.
In a cohort exclusively comprised of sporadic VS with documented growth, over 40% of tumors demonstrated no subsequent volumetric growth after 5 years of continued MRI surveillance. These data challenge the supposition that once growth occurs, all tumors will exhibit sustained growth. Continued observation after documented growth of sporadic VS is a reasonable consideration in appropriately selected cases.
在美国大多数中心，对有明确生长记录的散发性前庭神经鞘瘤（VS）进行确定性治疗是常见做法。然而，作为这一范例的自然延伸，关于生长肿瘤的自然病史几乎没有证据。目前工作的主要目的是描述在间隔磁共振成像（MRI）上记录到初始肿瘤生长后散发性 VS 的自然病史。
回顾性队列研究。
三级转诊中心。
2001 年 1 月 1 日至 2015 年 12 月 31 日期间诊断为散发性 VS 的患者，尽管在间隔 MRI 上显示肿瘤体积增长≥原肿瘤体积的 20%，但选择继续观察。
无后续体积生长的生存。
在研究期间进行连续影像学观察的 361 名患者中，85 名患者符合纳入标准，中位年龄为 66 岁（四分位间距[IQR]55-71）。在该队列中，40 名患者在最初 MRI 记录生长后中位数为 1.7 年（IQR 1.0-2.6）显示后续体积生长。中位体积增长率为 43%（IQR 28-57），增长率中位数为 0.026cm/年（IQR 0.009-0.107）。无后续体积生长率（95%CI；仍处于危险中的人数）的生存情况为 1 年为 93%（87-99；75），2 年为 67%（58-79；45），3 年为 54%（43-67；29），4 年为 44%（33-59；19），5 年为 41%（30-56；12）。
在仅由有明确生长记录的散发性 VS 组成的队列中，超过 40%的肿瘤在 MRI 连续监测 5 年后无后续体积生长。这些数据挑战了一旦发生生长，所有肿瘤都会持续生长的假设。在适当选择的情况下，在记录到散发性 VS 生长后继续观察是合理的考虑。
