Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Neurosurgery, NYU Langone Medical Center, New York, New York.
Otol Neurotol. 2023 Aug 1;44(7):e519-e524. doi: 10.1097/MAO.0000000000003934. Epub 2023 Jun 23.
In certain cases, clinicians may consider continued observation of a vestibular schwannoma after initial growth is detected. The aim of the current work was to determine if patients with growing sporadic vestibular schwannomas could be stratified by the likelihood of subsequent growth based on initial growth behavior.
Slice-by-slice volumetric tumor measurements from 3,505 serial magnetic resonance imaging studies were analyzed from 952 consecutively treated patients.
Three tertiary-referral centers.
Adults with sporadic vestibular schwannoma.
Wait-and-scan.
Composite end point of subsequent growth- or treatment-free survival rates, where growth is defined as an additional increase of at least 20% in tumor volume from the volume at the time of initial growth.
Among 405 patients who elected continued observation despite documented growth, stratification, of volumetric growth rate into less than 25% (reference: n = 107), 25 to less than 50% (hazard ratio [HR], 1.39; p = 0.06; n = 96), 50 to less than 100% (HR, 1.71; p = 0.002; n = 112), and at least 100% (HR, 2.01; p < 0.001; n = 90) change per year predicted the likelihood of future growth or treatment. Subsequent growth- or treatment-free survival rates (95% confidence interval) at year 5 after detection of initial growth were 31% (21-44%) for those with less than 25% growth per year, 18% (10-32%) for those with 25 to less than 50%, 15% (9-26%) for those with 50 to less than 100%, and 6% (2-16%) for those with at least 100%. Neither patient age ( p = 0.15) nor tumor volume at diagnosis ( p = 0.95) significantly differed across stratification groups.
At the time of diagnosis, clinical features cannot consistently predict which tumors will ultimately display aggressive behavior. Stratification by volumetric growth rate at the time of initial growth results in a stepwise progression of increasing likelihood of subsequent growth. When considering continued observation after initial growth detection, almost 95% of patients who have tumors that double in volume between diagnosis and the first detection of growth demonstrate further tumor growth or undergo treatment if observed to 5 years.
在某些情况下，临床医生可能会考虑在最初发现前庭神经鞘瘤生长后继续观察。本研究旨在确定生长的散发性前庭神经鞘瘤患者是否可以根据初始生长行为的可能性通过后续生长的可能性进行分层。
对 952 例连续治疗的患者的 3505 项连续磁共振成像研究的切片体积肿瘤测量值进行了分析。
三个三级转诊中心。
散发性前庭神经鞘瘤成人。
观察等待。
后续生长或无治疗生存的复合终点率，其中生长定义为肿瘤体积从初始生长时的体积增加至少 20%。
在 405 名尽管有记录的生长但仍选择继续观察的患者中，将体积增长率分层为小于 25%（参考：n = 107）、25 至小于 50%（风险比[HR]，1.39；p = 0.06；n = 96）、50 至小于 100%（HR，1.71；p = 0.002；n = 112）和至少 100%（HR，2.01；p < 0.001；n = 90），每年变化预测未来生长或治疗的可能性。初始生长后 5 年的后续生长或无治疗生存率（95%置信区间）分别为每年生长小于 25%的患者为 31%（21-44%），每年生长 25 至小于 50%的患者为 18%（10-32%），每年生长 50 至小于 100%的患者为 15%（9-26%），每年生长至少 100%的患者为 6%（2-16%）。患者年龄（p = 0.15）和诊断时肿瘤体积（p = 0.95）在分层组之间均无显著差异。
在诊断时，临床特征不能一致地预测哪些肿瘤最终会表现出侵袭性行为。根据初始生长时的体积增长率进行分层，会导致随后生长可能性的逐步增加。在最初的生长检测后考虑继续观察时，如果观察到 5 年，几乎 95%的肿瘤体积在诊断和首次生长检测之间翻倍的患者会出现肿瘤进一步生长或接受治疗。
