Abstract
ObjectivesTo develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy.DesignRetrospective cohort study.SettingTertiary hospital (Radboud university medical center, Nijmegen, the Netherlands).ParticipantsPatients with unilateral VS, entering a W&S strategy and at least one follow‐up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records.Main outcome measuresFollowing multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy.ResultsOf 1217 analysed VS patients, 653 (53.7%) showed growth during follow‐up. Balance complaints (HR 1.57 (95% CI: 1.31‐1.88)) and tinnitus complaints in the affected ear (HR 1.36 (95% CI: 1.15‐1.61)), Koos grade (Koos 1 is reference, Koos 2 HR 1.03 (95% CI: 0.80‐1.31), Koos 3 HR 1.55 (95% CI: 1.16‐2.06), Koos 4 HR 2.18 (95% CI: 1.60‐2.96)), time since onset of symptoms (IQR HR 0.83 (95% CI: 0.77‐0.88) and intrameatal diameter on MRI (IQR HR 1.67 (95% CI: 1.42‐1.96)) were selected as significant predictors. The model's discrimination (Harrell's C) was 0.69 (95% CI: 0.67‐0.71), and calibration was good. DCA showed that the model has a higher net benefit than the current strategy for probabilities of VS growth of >12%, 15% and 21% for the first consecutive 3 years, respectively.ConclusionsPatients with balance and tinnitus complaints, a higher Koos grade, short duration of symptoms and a larger intrameatal diameter at time of diagnosis have a higher probability of future VS growth. After external validation, this model may be used to inform patients about their prognosis, individualise the W&S strategy and improve (cost‐)effectiveness.
Highlights
Over the past years, conservative management of unilateral vestibular schwannoma (VS) has gained popularity.[1]
Short duration of symptoms and a larger intrameatal diameter at time of diagnosis have a higher probability of future VS growth
Largest VS diameter was measured in two directions on axial images, that is parallel to the internal auditory canal[9] and largest extrameatal diameter parallel to the petrous bone
Summary
Conservative management of unilateral vestibular schwannoma (VS) has gained popularity.[1]. A survey among otolaryngologists revealed several strategies, consisting of MRIs every 1-5 years, either continued until a specific age (75 or 80), for a specific period (4-21 years) or lifelong.[6] patients undergo a large number of MRIs during a lifetime. This contributes to the high costs associated with VS care and burdening of hospital visits for patients.[7] Preferably, we would select patients that need to be monitored carefully, because their VS has a high risk of future growth (and treatment), while others can be monitored less strictly or may even be omitted from further controls. The purpose of this study was to develop a clinical prediction model that can be used to predict VS growth for newly diagnosed patients assigned to a W&S strategy
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