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Otology/Neurotology

(245) Impact of Cell Proliferation Index and Fibroblasts in Vestibular Schwannoma

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Dominique Bohorquez, MD

    Resident
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Miami, Florida, United States

    • Co-Author(s)

  • OB

    Olena Bracho, BS

    Research Associate
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Miami, Florida, USA

  • Haley Hullfish, MD

    Medical Resident
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Naperville, Illinois, United States

  • Shriya Airen, MD

    Resident
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Edison, New Jersey, United States

  • MI

    Michael E. Ivan, MD, MBS

    Department of Neurological Surgery, University of Miami Miller School of Medicine
    Miami, Florida, USA

  • Fred F. Telischi, MEE, MD, FACS

    Chairman and Professor of Otolaryngology
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Miami, Florida, United States

    • Senior Author(s)

  • CD

    Christine T. Dinh, MD

    Associate Professor of Otolaryngology
    Department of Otolaryngology, University of Miami Miller School of Medicine
    Miami, Florida, USA

Disclosure(s):
Dominique Bohorquez, MD: No relevant relationships to disclose.
Haley Hullfish, MD: No relevant relationships to disclose.
Shriya Airen, MD: No relevant relationships to disclose.
Fred F. Telischi, MEE, MD, FACS: No relevant relationships to disclose.


Introduction: Vestibular schwannomas (VS) are benign intracranial neoplasms that arise from Schwann cells of the vestibulocochlear nerve. The tumor microenvironment plays a critical role in mediating tumor progression and hearing loss, of which fibroblasts represent the most abundant cell type.

Methods: This is a prospective cohort study of 76 patients who received VS surgery between May 2018 and December 2021. Tumor was harvested at the time of surgery, and immunohistochemistry (IHC) was performed to quantify Ki67 (cell proliferation) and S100A4 (fibroblast) expression. Ki67 was categorized as slowly ( < 3% total cells) and rapidly-dividing (≥3% total cells) groups. S100A4 was categorized as low ( < 1% total area) and high expression (≥1% total area). A chart review was performed to obtain demographics and determine preoperative maximum linear tumor dimension (small-to-medium ≤25 mm vs. large-to-giant >25 mm) and preoperative hearing status (serviceable vs. non-serviceable hearing).

Results: The mean age at surgery was 51 years. Of 76 patients, 55% were female, 38% had preoperative serviceable hearing, and 11% had NF2. Small-to-medium and large-to-giant tumors comprised 47% and 53% of patients, respectively. On univariate analysis, large-to-giant tumors had higher Ki67 expression (p=0.0498) and worse hearing (p=0.0083). On multivariate analysis, Ki67 expression (p=0.0357) and hearing (p=0.0077) were independent predictors of tumor size at time of surgery. S100A4, age, gender, and NF2 status were not predictive of hearing or tumor size (p>0.05).

Conclusions: In VS, higher cell proliferation and worse preoperative hearing were independent predictors of larger tumors at time of surgery. Fibroblast expression was not significantly associated with hearing, tumor size or cell proliferation index. Further investigations are warranted to understand the role of fibroblasts in the tumor microenvironment and the molecular factors that contribute to cell proliferation in VS.