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Social, Economic, and Demographic Determinants of Long-Term Survival in Nonvestibular Intracranial Schwannoma

Friday, May 3, 2024

    Presenting Author(s)

  • Gabrielle Hovis, BS

    Medical Student
    Department of Neurosurgery, University of California, Los Angeles
    Flagstaff, AZ, US

    • Co-Author(s)

  • RE

    Richard G. Everson, MD

    Assistant Professor
    Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
    Los Angeles, California, United States

  • Maya Harary, MD

    Neurosurgeon, Resident
    University of California Los Angeles
    Los Angeles, California, United States

  • SV

    Sanah Vohra, BS, MPH, PhD

    Medical Student
    Department of Neurosurgery, University of California, Los Angeles
    Los Angeles, California, United States

  • Isaac Yang, MD (he/him/his)

    Professor of Neurosurgery
    Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
    Los Angeles, California, United States

Introduction: Nonvestibular intracranial nerve schwannomas (NVCNS) comprise < 10% of intracranial schwannomas. Long-term survival is poorly characterized in the literature, with no existing reports addressing the sociodemographic impact on NVCNS survival.

Methods: The SEER database was queried from 2000-2022 using the ICD-O-3 code 9560/0 and primary site codes C72.2, C72.3, and C72.5. Vestibular schwannoma and cases lacking histologic or radiographic confirmation were excluded. Chi-square tests evaluated the relationship between race and age, sex, ethnicity, income, and residential area. Kaplan-Meier curves and log-rank tests assessed 10-year overall survival (OS) by sociodemographic characteristics. Cox proportional hazards regression estimated hazard ratios (HRs). All statistical analyses were conducted in SAS 9.4.

Results: There was a significant difference in age, ethnicity, income, and residential area by race (p-values: 0.001, < 0.0001, < 0.0001 and < 0.0001, respectively). Black and Asian individuals were predominately younger, non-Hispanic, and residents of areas with a population ≥1 million. Annual family income <$75,000 was seen in 75% of Black, 57% White, and 41% Asian individuals. At a >10-year follow-up, age, race, ethnicity, and residential area were significantly related to OS (p-value: < 0.0001, 0.006, 0.04, and 0.04, respectively). Adjusting for covariates, Asian individuals showed significantly lower all-cause-mortality hazards than White individuals [HR (95% CI): 0.66 (0.45, 0.99)], while Black individuals trended towards higher hazards than White individuals [1.38 (0.98, 1.96)]. In the adjusted model, younger ages had significantly lower all-cause-mortality hazards [≥15- < 45: 0.20 (0.15, 0.27); ≥45- < 55: 0.24 (0.17, 0.32); ≥55- < 65: 0.36 (0.28, 0.45) vs. ≥65], whereas male sex [1.20 (1.00, 1.43) vs. female] and populations < 1 million [1.24(1.02, 1.52) vs. population ≥1 million] had significantly higher risks.

Conclusion : We present the first report of long-term survival in NVCNS with multiple treatment modalities, and the first report of sociodemographic disparities in NVCNS. These disparities highlight key areas for health equity improvement.