Life Expectancy After Diagnosis of a Vestibular Schwannoma in Patients 70 Years and Older

Abstract

Importance: Over the past decades, the number of patients, especially in the older adult patient group, diagnosed with vestibular schwannoma (VS) has increased. Assuming that older adult patients have more comorbidities, a longer recovery period after surgery, a higher rate of surgical complications, and a higher mortality rate after VS surgery, a treatment strategy for this group of patients is warranted, based on clinical evidence on postsurgical survival.

Objective: To evaluate the survival after diagnosis of a VS in patients 70 years and older, treated with either observation or surgery, and to compare these findings with the life span of an age-matched background population in Denmark.

Design, setting, and participants: This was a retrospective cohort study of 624 patients 70 years and older diagnosed with VS in Denmark from 1976 to 2016. Since 1976, all patients with a VS have been registered in a national database, which contains 3637 patients. Of the included patients in this study, 477 were treated conservatively with the "wait-and-scan" strategy, and 147 were treated surgically with removal of the tumor. The survival of the patients was compared with a matched background population in Denmark. Data analysis was performed from January 1976 to January 2017.

Exposures: Surgery, radiotherapy, or none.

Main outcomes and measures: The main outcome was survival among the patients and compared with the matched background population.

Results: A total of 624 patients were included (317 female patients [50.8%] and 307 male patients [49.2%]). The mean (SD) survival in the observed patients was 9.2 (4.7) years after diagnosis, whereas for the background population, the expected survival was 11 years from the mean age at diagnosis. For the surgically treated patients, the mean (SD) survival was 11.8 (6.6) years, and expected survival was 11 years for the matched background population. The mean (SD) survival was 10.7 (5.5) years in female patients and 8.9 (5.0) years in male patients. There was no significant difference in survival between treatment modalities, irrespective of tumor size.

Conclusions and relevance: In this cohort study, survival after diagnosis of a VS in patients 70 years and older was similar in the surgical group compared with the age-matched background population. In the wait-and-scan group, the survival after diagnosis was marginally shorter, which may be associated with increased comorbidity.

Figure 1.. Pearson Correlation (Male and Female Combined) for Number of Vestibular Schwannomas (VS) Diagnosed Each Year and Number of VS Observed Each Year and Year of Observation

The figure shows a strong correlation between number of diagnosed VS and increasing year of observation as well as the number of observed VS, factoring in deaths over the years.

Figure 2.. Kaplan-Meier Survival Curves for Both Observation and Surgery Groups, Overall and Stratified for Different Tumor Sizes

None of the survival curves show significant difference in survival between the groups. See the Results section for specific hazard ratios.

Figure 3.. Scatterplot With Linear Measurements and Years of Survival in Observation and Surgery Groups After Diagnosis of a Vestibular Schwannoma

The figure shows a shift in treatment of vestibular schwannoma from observation to surgical removal as the tumors increase in size. Almost all the intrameatal tumors were observed (n = 210), except for 3 of the tumors, which are not visible in the plot (mean [SD] survival for patients with intrameatal tumors, 8.8 [4.4] years).

Figure 4.. Life Expectancy, in Years, From Age 70 Years and Older, in Male and Female Individuals in the Danish Population

According to data from the Danish Statistical Institute, the expected life span has increased. For example, for a woman aged 70 years in 1976, the expected survival was 13.8 years, compared with 16.8 years if she was aged 70 years in 2015. For the male population, the corresponding survival was 10.8 years and 14.5 years, respectively.