Article record

大型前庭神经鞘瘤次全切除术的长期结局：听神经瘤次全切除研究第二部分——肿瘤再生的结果

Long-Term Outcomes of Subtotal Resection for Large Vestibular Schwannomas: Results From the Acoustic Neuroma Subtotal Resection Study-Part II- Tumor Regrowth.

临床研究耳科IF 4.2Q1

文献信息

PMID	42714141
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Ashkan Monfared 查看其他 21 位作者 Richard K Gurgel；Philip V Theodosopoulos；Thomas L Haupt；Ronald E Warnick；Parisa Sabetrasekh；Carleton Eduardo Corrales；Yona Vaisbuch；Nikolas H Blevins；John S Oghalai；Alex D Sweeney；Marlan R Hansen；Bruce J Gantz；Rick F Nelson；Joe Walter Kutz；Brandon Isaacson；Moises A Arriaga；Sam Maghami；Richard L Amdur；Huan Zhang；Samuel H Selesnick；Robert K Jackler
作者单位	Department of Otolaryngology, George Washington University, Washington, District of Columbia, USA. 查看其他 16 条单位信息 Department of Neurosurgery, George Washington University, Washington, District of Columbia, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.；Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.；Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA.；Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA.；Department of Otolaryngology-Head and Neck Surgery, Massachusetts Ear and Eye Infirmary, Boston, Massachusetts, USA.；Department of Otolaryngology, Rambam Medical Center, Haifa, Israel.；Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA.；Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA.；Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.；Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern, Dallas, Texas, USA.；Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical School, New Orleans, Louisiana, USA.；Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA.；Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA.
期刊	Neurosurgery
SCI 分区	Q1
IF	4.2
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景与目的： 对大型前庭神经鞘瘤（VS）行次全切除术（STR）可能获得更好的面神经结局。然而，这种方法涉及非全肿瘤切除，也可能增加再生风险。目的是根据大型VS患者的切除范围来检查再生率的差异。
方法： 开展了一项多中心、前瞻性、非随机队列研究，纳入接受全切除术（GTR）、近全切除术（NTR）或STR的大型VS（≥2.5 cm）患者。GTR定义为无可见残留，NTR定义为术后MRI上残留<0.5 cm3或术中5 × 5 × 2 mm，STR定义为任何更大的残留。采用Cox比例风险模型评估肿瘤再生风险。
结果： 在126例患者中（平均随访：60 ± 31个月；平均肿瘤直径：3.3 ± 0.7 cm），35例接受GTR，39例接受NTR，52例接受STR。22例（17%）发生肿瘤再生。STR患者（27%）的再生风险是GTR患者（8%）的3倍（P = .02）。STR的中位再生时间（24个月）显著短于NTR或GTR（48个月，P = .03）。较大的残留肿瘤体积百分比（TV%）与再生相关（风险比1.73，95% CI，1.07-2.81，P = .02）。0.7 cm3的残留肿瘤体积和12%的TV%被确定为预测NTR再生的最佳截断点。
结论： STR与显著更高的肿瘤再生可能性相关。残留肿瘤残余的百分比与再生风险呈正相关。0.7 cm3的残留肿瘤体积和12%的TV%被确定为NTR的最佳截断值。在可行的情况下，应尝试GTR或NTR以尽量减少肿瘤再生的机会。

英文摘要

BACKGROUND AND OBJECTIVES: Subtotal resection (STR) of large vestibular schwannomas (VS) may achieve better facial nerve outcomes. However, this approach, involving less-than-total tumor removal, may also increase the risk of regrowth. The objective was to examine differences in the regrowth rate based on the extent of resection in patients with large VS.
METHODS: A multicenter, prospective, nonrandomized cohort study was conducted on patients with large VS (≥2.5 cm) who underwent gross total resection (GTR), near-total resection (NTR), or STR. GTR was defined as no visible remnant, NTR as a remnant <0.5 cm3 on postoperative MRI or 5 × 5 × 2 mm during surgery, and STR as any larger remnant. A Cox proportional hazard model assessed the risk of tumor regrowth.
RESULTS: Among 126 patients (mean follow-up: 60 ± 31 months; mean tumor diameter: 3.3 ± 0.7 cm), 35 underwent GTR, 39 NTR, and 52 STR. Tumor regrowth occurred in 22 cases (17%). STR patients (27%) had a 3-fold higher regrowth risk compared with GTR patients (8%) (P = .02). The median regrowth time for STR (24 months) was significantly shorter than for NTR or GTR (48 months, P = .03). A greater residual tumor volume percentage (TV%) was associated with regrowth (hazard ratio 1.73, 95% CI, 1.07-2.81, P = .02). A residual tumor volume of 0.7 cm3 and a TV% of 12% were identified as optimal cutoff points for predicting regrowth in NTR.
CONCLUSION: STR is associated with a significantly higher likelihood of tumor regrowth. The percentage of the residual tumor remnant is positively correlated with the risk of regrowth. A residual tumor volume of 0.7 cm3 and a TV% of 12% were identified as optimal cutoffs for NTR. When feasible, GTR or NTR should be attempted to minimize the chances of tumor regrowth.