Treatment strategies and survival outcomes of vestibular schwannoma: a comparative study based on Surveillance, Epidemiology, and End Results (SEER) database

Background: Treatment strategies for vestibular schwannoma (VS) vary widely, and selecting the optimal approach based on individual patient characteristics remains challenging. This study systematically evaluated the impact of different treatment modalities on survival outcomes and treatment-related risks using the Surveillance, Epidemiology, and End Results (SEER) database, and analyzed temporal trends and tumor size influences on treatment selection. Methods: A total of 10,081 patients diagnosed with VS between 2004 and 2021 were identified from the SEER database. Patients were categorized into four treatment groups: no treatment, surgery alone, radiotherapy (RT) alone, and combined surgery plus RT. To minimize baseline confounding, inverse probability of treatment weighting (IPTW) was employed. Comparative analyses of overall survival (OS) and treatment-related mortality risks were conducted across the four groups using Kaplan-Meier survival curves and cumulative incidence functions (CIFs). Additionally, temporal trends and tumor size influences on treatment groups were examined to provide clinical insights into individualized therapeutic strategies. Results: The surgery group showed the highest OS, with a 5-year survival rate of approximately 94%, compared to 78% in the no-treatment group (log-rank P