Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment.
Multifactor Influences of Shared Decision-Making in Acoustic Neuroma Treatment.
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DOI：
10.1097/mao.0000000000001292
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Francis HW
中科院分区：
文献类型：
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作者：
Nellis JC;Sharon JD;Pross SE;Ishii LE;Ishii M;Dey JK;Francis HW
确定与听神经瘤治疗方式选择相关的因素。前瞻性观察研究 三级护理神经科诊所 数据是前瞻性地从 2013 年至 2016 年间首次到三级护理神经科诊所就诊的患者收集的。没有 MRI、人口统计学、心理测量或听力测量数据的患者被排除在分析之外。收集人口统计信息、临床症状、肿瘤特征和心理测量数据，以使用单变量和多元逻辑回归分析确定与接受听神经瘤手术切除相关的因素。决定进行听神经瘤手术切除与主动监测。共有 216 名听神经瘤患者（平均年龄 55 岁，58% 女性）纳入研究。 98 名患者（45.4%）寻求手术切除，118 名患者（54.6%）寻求主动监测。手术治疗与患者年龄 < 65 岁、肿瘤级别较高、肿瘤生长、肿瘤体积较大、词语辨别得分较低、听力 D 级、出现症状的头痛和眩晕、总症状数量较多以及头痛严重程度得分较高显着相关 (p<0.05)。手术干预与术前生活质量、抑郁和自尊评分之间没有显着相关性。在多元逻辑回归分析中，65岁以上患者接受手术切除的可能性显着降低（OR 0.19; 0.05-0.69），中等肿瘤患者（OR 4.34; 1.36-13.81）、中等大小肿瘤（OR 33.47; 5.72-195.83）、大级别肿瘤（OR 56.63; 5.72-195.83）患者接受手术切除的可能性显着增加。 4.02-518.93), 存在肿瘤生长 （OR 4.51；1.66-12.28）、D 级听力（OR 3.96；1.29-12.16）以及较高的头痛严重程度评分（OR 1.03；95% CI 1.01-1.05）。对于巨大级别肿瘤，接受手术切除的可能性完全可以预测，而对于小级别肿瘤和 B 级或 C 级听力而言，则不显着。肿瘤较大、肿瘤不断生长、听力明显丧失和头痛更严重的非老年听神经瘤患者更有可能寻求手术切除，而不是主动监测。生活质量、抑郁和自尊等心理因素似乎不会影响该患者群体的决策。
To identify factors associated with treatment modality selection in acoustic neuromas. Prospective observational study Tertiary care neurotology clinic Data was prospectively collected from patients initially presenting to a tertiary care neurotology clinic between 2013 and 2016. Patients who did not have MRI, demographic, psychometric, or audiometric data were excluded from analysis. Demographic information, clinical symptoms, tumor characteristics, and psychometric data were collected to determine factors associated with undergoing acoustic neuroma surgical resection using univariate and multiple logistic regression analysis. The decision to pursue acoustic neuroma surgical resection versus active surveillance. A total of 216 patients with acoustic neuroma (mean age 55 years, 58% female) were included. 98 patients (45.4%) pursued surgical resection, 118 patients (54.6%) pursued active surveillance. Surgical treatment was significantly associated with patient age < 65, higher grade tumors, growing tumors, larger volume tumors, lower word discrimination scores, Class D hearing, headache and vertigo as presenting symptoms, higher number of total symptoms, and higher headache severity scores (p<0.05). There was no significant association between surgical intervention and preoperative quality of life, depression, and self-esteem scores. On multiple logistic regression analysis, the likelihood of undergoing surgical resection significantly decreased for patients older than age 65 (OR 0.19; 0.05-0.69) and increased in patients with medium (OR 4.34; 1.36-13.81), moderately large (OR 33.47; 5.72-195.83), large grade tumors (OR 56.63; 4.02-518.93), tumor growth present (OR 4.51; 1.66-12.28), Class D hearing (OR 3.96; 1.29-12.16), and higher headache severity scores (OR 1.03;95% CI 1.01-1.05). The likelihood of undergoing surgical resection was completely predictive for giant grade tumors and not significant for small grade tumors and Class B or C hearing. Non-elderly acoustic neuroma patients with larger tumors, growing tumors, significant hearing loss, and worse headaches are more likely to pursue surgical resection rather than active surveillance. Psychological factors such as quality of life, depression, and self-esteem do not seem to influence decision-making in this patient population.