Dörner Lorenz, Suhm Elisa-Maria, Ries Vanessa, Goncalves Vitor Moura, Skardelly Marco, Tatagiba Marcos, Schittenhelm Jens, Behling Felix
Department of Neurosurgery and Neurotechnology, University Hospital Tübingen, Eberhard-Karls-University, Baden-Württemberg, Tübingen, Germany, Hoppe-Seyler-Street 3, 72076.
Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University, Baden-Württemberg, Tübingen, Germany.
Acta Neuropathol Commun. 2025 Oct 3;13(1):211. doi: 10.1186/s40478-025-02127-4.
The extent of resection (EOR) is known to impact recurrence free survival in vestibular schwannomas (VS). Identifying predictive factors for complete resection may direct treatment decisions in the future. In recent years there is increasing evidence for the involvement of inflammatory processes in the development and growth of VS. It is currently unclear whether inflammatory changes may also play a role in the extent of resection in VS.
In this retrospective study, we analyzed clinical data, tumor extension, cystic characteristics and immunohistochemical markers for inflammation (CD68, CD163, CD3, CD8) and proliferation (MIB-1) as potential factors influencing the EOR in 1007 surgically treated primary sporadic VS. With CART-determined specific cut-offs for each inflammation marker, a common inflammatory score from 0 to 2 was determined. Univariate and multivariate analyses were performed for the EOR.
Total resection was achieved in 86.5% of cases. Incomplete resection was associated with advanced age (p = 0.0002), larger tumor size (p < 0.0001) and cystic characteristics on preoperative imaging (p < 0.0001). Increased expression of CD163, CD68 and CD3 (p < 0.0001, p = 0.0015 and p = 0.0024 respectively) was associated with partial tumor resection (PR). CD8 was significant when its CART-determined cut-off was considered (p = 0.0032). A higher inflammatory score was significantly connected to partial resection (p < 0.0001). In the multivariate analysis, larger size (p < 0.0001), older age (p = 0.0051), cystic characteristics (p = 0.0005) and higher CD68 expression (p = 0.0341) were independently significant factors for partial resection.
Advanced age, greater tumor extension, cystic growth and higher infiltration with macrophages are independent factors for a less radical extent of resection.
已知切除范围（EOR）会影响前庭神经鞘瘤（VS）的无复发生存率。确定完全切除的预测因素可能会指导未来的治疗决策。近年来，越来越多的证据表明炎症过程参与了VS的发生和发展。目前尚不清楚炎症变化是否也会在VS的切除范围中发挥作用。
在这项回顾性研究中，我们分析了1007例接受手术治疗的原发性散发性VS的临床数据、肿瘤扩展情况、囊性特征以及炎症（CD68、CD163、CD3、CD8）和增殖（MIB-1）的免疫组化标志物，将其作为影响EOR的潜在因素。根据CART确定的每种炎症标志物的特定临界值，确定了一个从0到2的常见炎症评分。对EOR进行单因素和多因素分析。
86.5%的病例实现了全切除。不完全切除与高龄（p = 0.0002）、肿瘤体积较大（p < 0.0001）以及术前影像学上的囊性特征（p < 0.0001）相关。CD163、CD68和CD3表达增加（分别为p < 0.0001、p = 0.0015和p = 0.0024）与部分肿瘤切除（PR）相关。当考虑其CART确定的临界值时，CD8具有显著性（p = 0.0032）。较高的炎症评分与部分切除显著相关（p < 0.0001）。在多因素分析中，体积较大（p < 0.0001）、年龄较大（p = 0.0051）、囊性特征（p = 0.0005）和CD68表达较高（p = 0.0341）是部分切除的独立显著因素。
高龄、肿瘤扩展较大、囊性生长以及巨噬细胞浸润较高是切除范围不够彻底的独立因素。
