Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management Clinical article
Vestibular schwannomas in the modern era: epidemiology, treatment trends, and disparities in management Clinical article
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DOI：
10.3171/2013.1.jns121370
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发表时间：
2013-07-01
影响因子：
4.1
通讯作者：
Adamson, Cory
中科院分区：
文献类型：
--
作者：
Babu, Ranjith;Sharma, Richa;Adamson, Cory
物体。前庭神经鞘瘤(VSS)的治疗有多种选择，包括显微手术切除、放射治疗和观察。虽然治疗的选择取决于不同的患者因素，但医生的偏见已被证明显著影响VS的治疗选择。在这项研究中，作者描述了VS的当前流行病学和现代美国的治疗趋势。它们还说明了患者和肿瘤的特点，并阐明了它们对肿瘤处理的影响。诊断为VS的患者通过监测、流行病学和最终结果数据库确定，时间跨度为2004-2009年。使用2000年美国标准人口计算和调整年龄调整后的发病率。卡方检验和学生t检验用于评估患者和肿瘤特征之间的差异。多因素Logistic回归分析确定不同患者和肿瘤特征对肿瘤治疗选择的影响。共有6225名VSS患者在2004至2009年间接受治疗。总发病率为每年每10万人1.2人。VS患者的中位年龄为55岁，大多数患者是高加索人(83.16%)。其中单纯手术3053例(49.04%)，单纯放疗1466例(23.55%)。123例(1.98%)同时接受手术和放疗，1504例(24.16%)未接受任何治疗。年龄增长与手术次数减少相关(OR0.95，95%CI0.95-0.96；P<；0.0001)，而肿瘤大小与手术次数增加相关(OR1.04，95%CI1.04-1.05；P<；0.0001)。年龄越大，保守治疗的可能性越大(OR1.04，95%CI1.04-1.05；P<；0.0001)。种族差异也被发现，与高加索人相比，非洲裔美国人患者接受手术治疗的可能性显著降低(OR0.50，95%CI0.35-0.70；p<；0.0001)，尽管确诊时肿瘤较大。在美国，前庭神经鞘瘤的发病率为每年每10万人1.2例。虽然许多研究表明，对中小型VSS采用放射治疗可以改善预后，但手术仍然是这些肿瘤最常用的治疗方式。VSS的治疗也存在种族差异，尽管出现较大的肿瘤，但非裔美国患者接受手术的可能性是前者的一半，接受VSS保守治疗的可能性几乎是后者的两倍。需要进一步的研究来阐明治疗差异的原因，并调查全国范围内切除治疗小型VSS的趋势。
Object. There are a variety of treatment options for the management of vestibular schwannomas (VSs), including microsurgical resection, radiotherapy, and observation. Although the choice of treatment is dependent on various patient factors, physician bias has been shown to significantly affect treatment choice for VS. In this study the authors describe the current epidemiology of VS and treatment trends in the US in the modern era. They also illustrate patient and tumor characteristics and elucidate their effect on tumor management.Methods. Patients diagnosed with VS were identified through the Surveillance, Epidemiology, and End Results database, spanning the years 2004-2009. Age-adjusted incidence rates were calculated and adjusted using the 2000 US standard population. The chi-square and Student t-tests were used to evaluate differences between patient and tumor characteristics. Multivariate logistic regression was performed to determine the effects of various patient and tumor characteristics on the choice of tumor treatment.Results. A total of 6225 patients with VSs treated between 2004 and 2009 were identified. The overall incidence rate was 1.2 per 100,000 population per year. The median age of patients with VS was 55 years, with the majority of patients being Caucasian (83.16%). Of all patients, 3053 (49.04%) received surgery only, with 1466 (23.55%) receiving radiotherapy alone. Both surgery and radiation were only used in 123 patients (1.98%), with 1504 patients not undergoing any treatment (24.16%). Increasing age correlated with decreased use of surgery (OR 0.95, 95% CI 0.95-0.96; p < 0.0001), whereas increasing tumor size was associated with the increased use of surgery (OR 1.04, 95% CI 1.04-1.05; p < 0.0001). Older age was associated with an increased likelihood of conservative management (OR 1.04, 95% CI 1.04-1.05; p < 0.0001). Racial disparities were also seen, with African American patients being significantly less likely to receive surgical treatment compared with Caucasians (OR 0.50, 95% CI 0.35-0.70; p < 0.0001), despite having larger tumors at diagnosis.Conclusions. The incidence of vestibular schwannomas in the US is 1.2 per 100,000 population per year. Although many studies have demonstrated improved outcomes with the use of radiotherapy for small- to medium-sized VSs, surgery is still the most commonly used treatment modality for these tumors. Racial disparities also exist in the treatment of VSs, with African American patients being half as likely to receive surgery and nearly twice as likely to have their VSs managed conservatively despite presenting with larger tumors. Further studies are needed to elucidate the reasons for treatment disparities and investigate the nationwide trend of resection for the treatment of small VSs.