Abstract
Acetylsalicylic acid has been linked to a lower risk for different cancer types, presumably through its inhibitory effect on cyclooxygenase 2. This has also been investigated in vestibular schwannomas with promising results suggesting an antiproliferative effect and recently the intake has been recommended for vestibular schwannomas as a conservative treatment option. We constructed tissue microarrays from paraffin-embedded tissue samples of 1048 vestibular schwannomas and analyzed the expression of cyclooxygenase 2 and the proliferation marker MIB1 (Molecular Immunology Borstel) via immunohistochemistry together with clinical data (age, gender, tumor extension, prior radiotherapy, neurofibromatosis type 2, tumor recurrence, cyclooxygenase 2 responsive medication). Univariate analysis showed that cyclooxygenase 2 expression was increased with age, female gender, prior radiotherapy and larger tumor extension. MIB1 expression was also associated with higher cyclooxygenase 2 expression. Schwannomas of neurofibromatosis type 2 patients had lower cyclooxygenase 2 levels. Use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs, glucocorticoids or other immunosuppressants did not show differences in cyclooxygenase 2 or MIB1 expression. Instead, cyclooxygenase 2 expression increases with tumor extension while MIB1 expression is not associated with tumor size. Overall, cyclooxygenase 2 expression is associated with proliferation but not influenced by regular intake of acetylsalicylic acid or other cyclooxygenase 2-responsive medications. Acetylsalicylic acid intake does not alter cyclooxygenase 2 expression and has no antiproliferative effect in vestibular.
Highlights
Vestibular schwannoma (VS) is a benign tumor entity arising from the vestibular nerve, with an incidence of approximately 1:100,000, accounting for 6–7% of all intracranial tumors [22]
Patient cohort We performed an electronic database search, showing that 1144 vestibular schwannomas were surgically treated in the authors’ institution between October 2003 and March 2017
Demographic characteristics Between October 2003 and March 2017, 1144 vestibular schwannomas were surgically treated in the authors’
Summary
Vestibular schwannoma (VS) is a benign tumor entity arising from the vestibular nerve, with an incidence of approximately 1:100,000, accounting for 6–7% of all intracranial tumors [22]. There are no known risk factors for the development of sporadic vestibular schwannomas (sVS), which constitute the majority of cases [4]. 22 resulting in a deficiency of the peptide merlin, typically have bilateral vestibular schwannomas at a relatively young age in addition to other intracranial and intraspinal tumors [8]. In these cases, bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A), is an off-label treatment option that can slow tumor growth [23]. There is very little evidence for that specific patient subgroup regarding treatment with non-steroidal anti-inflammatory drugs (NSAIDs)
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