Residual Tumor Volume and Location Predict Progression After Primary Subtotal Resection of Sporadic Vestibular Schwannomas: A Retrospective Volumetric Study
Residual Tumor Volume and Location Predict Progression After Primary Subtotal Resection of Sporadic Vestibular Schwannomas: A Retrospective Volumetric Study
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DOI：
10.1093/neuros/nyz200
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发表时间：
2020-03-01
期刊：
影响因子：
4.8
通讯作者：
Theodosopoulos, Philip, V
中科院分区：
文献类型：
--
作者：
Breshears, Jonathan D.;Morshed, Ramin A.;Theodosopoulos, Philip, V
背景：在以患者为中心的医疗决策时代，保留前庭神经鞘瘤手术的功能完整性已成为关键。当肿瘤和关键结构之间存在致密粘连时，通常需要进行肿瘤大部切除。然而，目前尚不清楚次全切除（STR）后的肿瘤控制率以及与复发相关的因素。目的：确定STR术后肿瘤残留生长率，并确定肿瘤进展的临床和影像学预测指标。方法：对2002年1月1日至2015年12月31日期间接受手术切除的所有散发性前庭神经鞘瘤进行单机构回顾性研究。我们回顾了临床图表、病理、放射学和手术报告。对所有术前和术后磁共振成像进行体积分析。采用单因素和多因素logistic回归来确定肿瘤进展主要终点的预测因素。Kaplan-Meier分析比较两组肿瘤残留体积和部位的无进展生存期。结果：在66例接受原发性STR的患者中，30%的患者在中位随访时间为3.1年的时间内出现进展。多因素分析显示，更大的残留肿瘤体积（OR 2.0[1.1-4.0]）和内耳道内残留疾病（OR 3.7[1.0-13.4]）预示着进展。结论：这些纵向数据提供了对残留肿瘤行为的深入了解，帮助临床医生确定STR是否以及何时是一种可接受的手术策略，并在与患者共享医疗决策咨询时锚定期望。
BACKGROUND: Preservation of functional integrity during vestibular schwannoma surgery has become critical in the era of patient-centric medical decision-making. Subtotal tumor removal is often necessary when dense adhesions between the tumor and critical structures are present. However, it is unclear what the rate of tumor control is after subtotal resection (STR) and what factors are associated with recurrence.OBJECTIVE: To determine the rate of residual tumor growth after STR and identify clinical and radiographic predictors of tumor progression.METHODS: A single-institution retrospective study was performed on all sporadic vestibular schwannomas that underwent surgical resection between January 1, 2002 and December 31, 2015. Clinical charts, pathology, radiology, and operative reports were reviewed. Volumetric analysis was performed on all pre- and postoperative MR imaging. Univariate and multivariate logistic regression was performed to identify predictors of the primary endpoint of tumor progression. Kaplan-Meier analysis was performed to compare progression free survival between 2 groups of residual tumor volumes and location.RESULTS: In this cohort of 66 patients who underwent primary STR, 30% had documented progression within a median follow up period of 3.1 yr. Greater residual tumor volume (OR 2.0 [1.1-4.0]) and residual disease within the internal auditory canal (OR 3.7 [1.0-13.4]) predicted progression on multivariate analysis.CONCLUSION: These longitudinal data provide insight into the behavior of residual tumor, helping clinicians to determine if and when STR is an acceptable surgical strategy and to anchor expectations during shared medical decision-making consultation with patients.