Subtotal resection of vestibular schwannoma: Evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation

Iannella, Giannicola; Vincentiis, Marco de; Gioia, Cira Di; Carletti, Raffaella; Pasquariello, Benedetta; Manno, Alessandra; Angeletti, Diletta; Savastano, Ersilia; Magliulo, Giuseppe

doi:10.1177/0300060516686873

Cited by 15 publications

(20 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, in a case series with 15 clinically aggressive vestibular schwannomas that all showed a radiological growth rate of > 15 mm/year, MIB1 expression was significantly increased compared to a control group [14]. It has also been described that the risk of regrowth after VS resection is associated with an increased MIB1 expression [9, 15].…”

Section: Discussionmentioning

confidence: 99%

COX2 expression is associated with proliferation and tumor extension in vestibular schwannoma but is not influenced by acetylsalicylic acid intake

Behling

Ries

Skardelly

et al. 2019

acta neuropathol commun

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

COX2 expression is associated with proliferation and tumor extension in vestibular schwannoma but is not influenced by acetylsalicylic acid intake

Behling

Ries

Skardelly

et al. 2019

acta neuropathol commun

View full text Add to dashboard Cite

show abstract

“…The MIB-1 index was not significantly correlated with regrowth or recurrence despite our finding that the mean value of the MIB-1 index was slightly higher in the cases with recurrence. In the literature, the MIB-1 index has been associated with recurrence [22,46]. A retrospective study of 17 patients by Iannella et al [22] claimed that a MIB-1 index > 2.5% is a predictor of tumour regrowth and that these patients should be carefully monitored by radiological follow-up.…”

Section: Mib-1 Proliferation Indexmentioning

confidence: 99%

“…In the literature, the MIB-1 index has been associated with recurrence [22,46]. A retrospective study of 17 patients by Iannella et al [22] claimed that a MIB-1 index > 2.5% is a predictor of tumour regrowth and that these patients should be carefully monitored by radiological follow-up. Strong evidence for a significant association between the MIB-1 index and tumour recurrence in vestibular schwannoma is provided in the study by Panigrahi et al [32] which investigated 144 patients who underwent surgical excision for sporadic vestibular schwannoma.…”

Section: Mib-1 Proliferation Indexmentioning

confidence: 99%

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

et al. 2020

View full text Add to dashboard Cite

Background Facial nerve palsy is a severe morbid condition that occurs after vestibular schwannoma (VS) surgery. The objective of this study was to evaluate facial nerve outcomes based on surgical techniques, tumour size, and immunohistochemical factors. Methods One hundred eighteen patients with VS were retrospectively analysed. Gross total resection (GTR) was achieved in 83 patients, and subtotal resection (STR) was achieved in 35 patients. Follow-up was 60 months (median). Facial nerve outcomes were assessed for 24 months after surgery. Analysis of the MIB-1 index was performed in 114 patients (97%) to evaluate recurrence and facial nerve outcomes. Results Immediately after surgery, 16 of 35 patients (45.7%) with STR and 21 of 83 patients (25.3%) with GTR had a good (House-Brackmann (HB) score ≤ 2) facial nerve outcome (p = 0.029). Semi-sitting positioning (p = 0.002) and tumour size class of 3 (> 4 cm) were also associated with worse HB outcomes after 2 years (p = 0.004) in univariate analyses. The MIB-1 index was significantly correlated with diffuse infiltration of tumour-associated CD45 + lymphocytes (r = 0.63, p = 0.015) and CD68 + macrophages (r = 0.43, p = 0.021). ROC analysis found an AUC of 0.73 (95% CI = 0.60-0.86, p = 0.003) for the MIB-1 index in predicting poor facial nerve outcomes. Binary logistic regression analysis revealed an MIB-1 index ≥ 5% (16/28 (57.1%) vs. 5/ 40 (12.5%); p < 0.001, OR = 14.0, 95% CI = 3.2-61.1) and a tumour size class of 3 (6/8 (75.0%) vs. 2/8 (25.0%); p = 0.01, OR = 14.56, 95% CI = 1.9-113.4) were predictors of poor HB scores (≥ 3) after 1 year. Conclusions An MIB-1 index ≥ 5% seems to predict worse long-term facial nerve outcomes in VS surgery.

show abstract

“…Therefore, it is important to understand the behavior of residual tumors following an incomplete resection. Some authors showed that small, devascularized residual tumors do not grow 18 – 20 , while others proved that the proliferative activity of the tumor itself contributes to regrowth 21 – 23 . The question of whether the residual tumor will grow or not will depend on the pattern of regrowth, in which the incidence and rate of regrowth, and the benefit on neurological outcome need to be addressed.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors including EOR 16 , 17 , 28 , residual tumor volume 17 , 25 , 27 , 34 – 36 , and the proliferative activity of the tumor itself 21 – 23 have been reported to contribute to regrowth after incomplete resection of VS, but still, little is known about the significant clinicopathological factors 24 , 26 , 29 – 33 . In this study, an immediate postoperative tumor volume ≥ 0.7 cm 3 had almost an 11-fold greater risk and residual tumor location other than IAC had a sixfold greater risk of a regrowth than tumors that were less than 0.7 cm 3 or in IAC.…”

Section: Discussionmentioning

confidence: 99%

The behavior of residual tumors following incomplete surgical resection for vestibular schwannomas

Park

et al. 2021

Sci Rep

View full text Add to dashboard Cite

The management of vestibular schwannoma (VS) with residual tumor following incomplete resection remains controversial and little is known regarding postoperative tumor volume changes. The behavior of residual tumors was analyzed for 111 patients who underwent surgery for newly diagnosed VS between September 2006 and July 2017. The postoperative tumor volume changes were assessed during a mean follow-up of 69 months (range 36–147 months). Fifty-three patients underwent imaging surveillance following incomplete resection. There was no residual tumor growth in 44 patients (83%). A significant regression of residual tumor volume was noted in the no growth group at postoperative 1 year (p = 0.028), 2 years (p = 0.012), but not from 3 years onwards. Significant predictors of regrowth were immediate postoperative tumor volume ≥ 0.7 cm3 (HR 10.5, p = 0.020) and residual tumor location other than the internal auditory canal (IAC) (HR 6.2, p = 0.026). The mean time to regrowth was 33 months (range 5–127 months). The 2-, 5-, and 10-year regrowth-free survival rates were 90.6%, 86.8%, and 83%, respectively. In conclusion, significant residual tumor regression could occur within 2 years for a VS with an immediate postoperative tumor volume less than 0.7 cm3 or residual tumor in IAC.

show abstract

Subtotal resection of vestibular schwannoma: Evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation

Cited by 15 publications

References 34 publications

COX2 expression is associated with proliferation and tumor extension in vestibular schwannoma but is not influenced by acetylsalicylic acid intake

COX2 expression is associated with proliferation and tumor extension in vestibular schwannoma but is not influenced by acetylsalicylic acid intake

The impact of the MIB-1 index on facial nerve outcomes in vestibular schwannoma surgery

The behavior of residual tumors following incomplete surgical resection for vestibular schwannomas

Contact Info

Product

Resources

About