前庭神经鞘瘤诊断和治疗中的社会经济差异：一项系统综述。

文献信息

中文摘要

背景： 神经外科诊疗中的差异日益受到认识，但其如何影响前庭神经鞘瘤（VS）的诊断和治疗仍不清楚。诊断时肿瘤大小、治疗选择及结局的差异可能受种族、保险状况、收入和地理因素的影响。迄今为止，尚无全面综述探讨散发性VS患者中的这些不公平现象。
目的： 系统评价文献中关于社会健康决定因素（SDoH）在散发性前庭神经鞘瘤患者诊断、治疗和结局中作用的证据。
方法： 我们按照PRISMA指南对PubMed、Embase和Web of Science（2000-2024年）进行了系统综述。纳入的研究检查了成人散发性VS患者，并报告了至少一个社会经济变量。非英语研究及涉及儿科患者的研究被排除。聚焦于2型神经纤维瘤病的研究被排除。筛选和数据提取由多名评价者使用Covidence独立进行。关注的结局包括肿瘤大小、治疗方式（手术、放射外科、观察）、听力保留、并发症和复发。研究质量采用GRADE框架评估，并在偏倚风险、不一致性、间接性、不精确性和发表偏倚等领域进行评价。
结果： 在识别出的487条记录中，40项符合纳入标准。大多数为基于美国的回顾性研究，利用国家数据库进行患者招募。种族和保险状况是最常报告的变量；收入和地理指标较少被评估。结局描述了接受治疗的可能性，包括手术或SRS、并发症（包括发病率和死亡率）、住院时间以及出院去向（包括康复和再入院）。少数研究评估了功能状态（n=2）、听力结局（n=2）或生活质量（n=1）。在分析的40项研究中，共纳入358,843名患者。
结论： 本综述提示，前庭神经鞘瘤诊疗中的差异是多因素的，其中种族和保险状况在治疗、结局和差异之间显示出最一致的关联。随着治疗不断演变并趋于集中化，未来的工作应优先开展多机构研究，以纳入患者层面的社会经济数据，并评估治疗选择之外的结局。

英文摘要

Disparities in neurosurgical care are increasingly recognized, yet how they affect the diagnosis and management of vestibular schwannoma (VS) remains unclear. Differences in tumor size at diagnosis, treatment selection, and outcomes may be influenced by race, insurance status, income, and geography. To date, no comprehensive synthesis has addressed these inequities in patients with sporadic VS. To systematically evaluate the literature for evidence of social determinants of health (SDoH) in the diagnosis, treatment, and outcomes of patients with sporadic vestibular schwannoma. We conducted a PRISMA-guided systematic review of PubMed, Embase, and Web of Science (2000-2024). Included studies examined adult patients with sporadic VS and reported at least one socioeconomic variable. Non-English studies and those involving pediatric patients were excluded. Studies focusing on neurofibromatosis type 2 were excluded. Screening and data extraction were conducted independently by multiple reviewers using Covidence. Outcomes of interest included tumor size, treatment modality (surgery, radiosurgery, observation), hearing preservation, complications, and recurrence. Study quality was assessed using the GRADE framework and evaluated across the domains of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Of 487 records identified, 40 met inclusion criteria. Most were US-based, retrospective studies that utilized national databases for patient recruitment. Race and insurance status were the most frequently reported variables; income and geographic indicators were less commonly assessed. Outcomes described the likelihood of treatment received, including surgery or SRS, complications including morbidity and mortality, length of stay, and discharge disposition including rehab and readmission. Few studies assessed functional status (n=2), hearing outcomes (n=2), or quality of life (n=1). In total, 358,843 patients were included across the 40 studies analyzed. This review suggests that disparities in vestibular schwannoma care are multi-factorial, with race and insurance status showing the most consistent associations between management, outcomes, and disparities. As treatment continues to evolve and become more centralized, future work should prioritize multi-institutional studies to incorporate patient-level socioeconomic data and evaluate outcomes beyond management selection.