(0941) Impact of Sociodemographic and Clinical Factors on Intervention in Initially Observed Vestibular Schwannomas

Introduction: There is significant evidence for disparities in diagnosis, care, and outcomes related to age, socioeconomic status, and race in initial treatment of spontaneous vestibular schwannoma (VS); however, less is known about outcomes for those patients who initially undergo observation. The purpose of this study was to determine sociodemographic and clinical factors that may impact the decision to eventually intervene with surgery or radiation in these patients.

Methods: A retrospective chart review was performed of patients with diagnosis of VS (ICD 10 code: D33.3) seen by a neurotologist between August 1, 2013 and July 31, 2023 within a single tertiary care institution. Patients seen for initial consultation of newly diagnosed VS, with at least one follow-up visit with audiometry and MRI imaging, were included. Demographics, objective clinical data, symptoms, and management decisions were recorded longitudinally. Logistic regression was performed including predictors of age, sex, race, tumor size at presentation, change in tumor size, change in hearing, an age by tumor change interaction, and an age by hearing change interaction.

Results: In total, 233 patients were included in the study. Of them, 69 patients (29.6%) eventually underwent intervention with surgery or radiation. Neither of the interaction terms were significant in the logistic regression model. Using a model without interaction terms to assess the main effects of the predictors, there was an association between intervention status and age (OR: 0.334 for ≥ 65 years vs < 65 years, 95% CI [0.168, 0.664], p = 0.0018), tumor size at presentation (OR: 1.101, 95% CI [1.032, 1.174], p = 0.0034), and change in tumor size (OR: 3.843 for change vs no change, 95% CI [1.962, 7.529], P < 0.0001). There was no evidence of an association between intervention and sex, race, or change in hearing.

Conclusions: Younger age, larger tumor size at presentation, and tumor growth were associated with increased odds of eventual intervention, whereas other demographic factors in this single-site study were not significantly associated with odds of intervention.