PubMed abstract / permitted excerpt

OBJECTIVE: Vestibular schwannoma (VS) is a benign intracranial tumor that is increasingly diagnosed in older adults. The relative contributions of tumor burden and surgical management to overall survival in elderly and very elderly patients remain incompletely characterized at a population level in VS patients. STUDY DESIGN: Retrospective Cohort. SETTING: SEER Database study between the years 2000 and 2022 to identify patients aged 70 to 89 years diagnosed with VS. METHODS: Patients were stratified into very elderly (80-89 years) and elderly (70-79 years) cohorts. Overall survival was assessed using Kaplan-Meier methods and multivariable Cox proportional hazards models. RESULTS: A total of 4156 patients were included (950 aged 80-89 years; 3206 aged 70-79 years). Overall survival was shorter in patients aged 80 to 89 years (median 46 months) compared with those aged 70 to 79 years (median 61 months) (P < .001). In the 80 to 89-year cohort, tumor size was independently associated with mortality when modeled continuously (HR 1.07 per 10-mm increase; 95% CI 1.03-1.12; P < .001). In a subanalysis of surgical patients aged 80 to 89 years, tumors ≤32 mm were associated with better overall survival compared with tumors >32 mm (HR 0.23; 95% CI 0.10-0.57; P = .001). In patients aged 70 to 79 years, survival differed by resection group, and gross total resection was associated with overall survival in adjusted analyses (HR 1.48; 95% CI 1.13-1.93; P = .005). CONCLUSION: In this dataset, surgical resection status was not associated with overall survival in patients aged 80 to 89 years, whereas associations between resection status and overall survival were observed in patients aged 70 to 79 years. These findings should be interpreted cautiously because this study cannot account for treatment-selection factors such as frailty, comorbidity burden, symptom severity, or treatment intent.