Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
Neuro Oncol. 2022 Aug 1;24(8):1298-1306. doi: 10.1093/neuonc/noab303.
The current study aims to characterize the natural history of sporadic vestibular schwannoma volumetric tumor growth, including long-term growth patterns following initial detection of growth.
Volumetric tumor measurements from 3505 serial MRI studies were analyzed from unselected consecutive patients undergoing wait-and-scan management at three tertiary referral centers between 1998 and 2018. Volumetric tumor growth was defined as a change in volume ≥20%.
Among 952 patients undergoing observation, 622 experienced tumor growth with initial growth-free survival rates (95% CI) at 1, 3, and 5 years following diagnosis of 66% (63-69), 30% (27-34), and 20% (17-24). Among 405 patients who continued to be observed despite demonstrating initial growth, 210 experienced subsequent tumor growth with subsequent growth-free survival rates at 1, 3, and 5 years following initial growth of 77% (72-81), 37% (31-43), and 24% (18-31). Larger tumor volume at initial growth (HR 1.13, P = .02) and increasing tumor growth rate (HR 1.31; P < .001) were significantly associated with an increased likelihood of subsequent growth, whereas a longer duration of time between diagnosis and detection of initial growth was protective (HR 0.69; P < .001).
While most vestibular schwannomas exhibit an overall propensity for volumetric growth following diagnosis, prior tumor growth does not perfectly predict future growth. Tumors can subsequently grow faster, slower, or demonstrate quiescence and stability. Larger tumor size and increasing tumor growth rate portend a higher likelihood of continued growth. These findings can inform timing of intervention: whether upfront at initial diagnosis, after detection of initial growth, or only after continued growth is observed.
本研究旨在描述散发性前庭神经鞘瘤容积肿瘤生长的自然史，包括初始发现生长后的长期生长模式。
对 1998 年至 2018 年间，在三个三级转诊中心接受等待和扫描管理的未选择的连续患者的 3505 项连续 MRI 研究中的容积肿瘤测量值进行了分析。容积肿瘤生长定义为体积变化≥20%。
在 952 例接受观察的患者中，622 例患者出现肿瘤生长，初始无生长生存率（95%CI）在诊断后 1、3 和 5 年分别为 66%（63-69）、30%（27-34）和 20%（17-24）。在 405 例初始生长后继续观察的患者中，210 例患者随后出现肿瘤生长，初始生长后 1、3 和 5 年的无生长生存率分别为 77%（72-81）、37%（31-43）和 24%（18-31）。初始生长时肿瘤体积较大（HR 1.13，P =.02）和肿瘤生长速度加快（HR 1.31；P <.001）与随后生长的可能性增加显著相关，而诊断和检测初始生长之间的时间间隔较长则具有保护作用（HR 0.69；P <.001）。
尽管大多数前庭神经鞘瘤在诊断后总体上倾向于体积生长，但先前的肿瘤生长并不能完全预测未来的生长。肿瘤随后可能生长更快、更慢或表现出静止和稳定。肿瘤体积较大和肿瘤生长速度加快预示着继续生长的可能性更高。这些发现可以为干预时机提供信息：是在初始诊断时立即进行，还是在检测到初始生长后进行，还是仅在观察到持续生长后进行。
