The Influence of Vestibular Schwannoma Tumor Volume and Growth on Hearing Loss
The Influence of Vestibular Schwannoma Tumor Volume and Growth on Hearing Loss
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DOI：
10.1177/0194599819900396
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发表时间：
2020-01-28
影响因子：
3.4
通讯作者：
Carlson, Matthew L.
中科院分区：
文献类型：
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作者：
Patel, Neil S.;Huang, Alice E.;Carlson, Matthew L.
目的探讨前庭神经鞘瘤（VS）的体积、生长与听力损失的关系。研究设计回顾性队列研究。设置单一三级中心。研究对象和方法纳入了诊断时观察到VS和听力正常的成年人。主要结局是使用Kaplan-Meier方法估计的听力丧失。使用斯皮尔曼等级相关系数评估肿瘤体积与基线听力的相关性。使用考克斯比例风险模型评估音量和生长与随时间发展的不可用听力的相关性，并使用风险比（HR）进行总结。结果在230例VS和听力正常的患者中，213例有连续的肿瘤体积数据可供分析。诊断时肿瘤体积越大，纯音平均值（PTA）越高（P <0.001），单词识别评分（WRS）越低（P = 0.014）。在诊断后6年和10年的听力保持率分别为67%和49%。在单变量环境中，较大的初始肿瘤体积与听力丧失相关（增加1 cm 3的HR：1.36，P = 0.040），但在校正PTA和WRS后则不相关。肿瘤生长与听力丧失时间无显著相关性（HR，1.57; P = 0.14），尽管在观察过程中，估计的听力保持率在经历生长的组中较差。结论较大的初始VS肿瘤体积与基线时听力较差相关。在单变量环境下观察期间，较大的初始肿瘤体积也与听力受损相关;然而，在调整基线听力状态后，这种相关性没有统计学意义。
Objective To ascertain the relationship among vestibular schwannoma (VS) tumor volume, growth, and hearing loss. Study Design Retrospective cohort study. Setting Single tertiary center. Subjects and Methods Adults with observed VS and serviceable hearing at diagnosis were included. The primary outcome was the development of nonserviceable hearing as estimated using the Kaplan-Meier method. Associations of tumor volume with baseline hearing were assessed using Spearman rank correlation coefficients. Associations of volume and growth with the development of nonserviceable hearing over time were assessed using Cox proportional hazards models and summarized with hazard ratios (HRs). Results Of 230 patients with VS and serviceable hearing at diagnosis, 213 had serial volumetric tumor data for analysis. Larger tumor volume at diagnosis was associated with increased pure-tone average (PTA) (P < .001) and decreased word recognition score (WRS) (P = .014). Estimated rates of maintaining serviceable hearing at 6 and 10 years following diagnosis were 67% and 49%, respectively. Larger initial tumor volume was associated with development of nonserviceable hearing in a univariable setting (HR for 1-cm(3) increase: 1.36, P = .040) but not after adjusting for PTA and WRS. Tumor growth was not significantly associated with time to nonserviceable hearing (HR, 1.57; P = .14), although estimated rates of maintaining serviceable hearing during observation were poorer in the group that experienced growth. Conclusion Larger initial VS tumor volume was associated with poorer hearing at baseline. Larger initial tumor volume was also associated with the development of nonserviceable hearing during observation in a univariable setting; however, this association was not statistically significant after adjusting for baseline hearing status.