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<0.001). Combined therapy and RT alone had intermediate 5-year survival rates of about 89% and 85%, respectively. These differences remained significant after IPTW adjustment. In the competing risks analysis (36 treatment-related deaths), the surgery alone group was not associated with a statistically significant increase in treatment-related mortality [subdistribution hazard ratio (sub-HR) =0.60; P=0.22], nor was RT alone (sub-HR =1.02; P=0.95); the combined group had zero events, leading to an unstable estimate. Treatment choices evolved over time and were strongly influenced by tumor size. Conclusions: In this large, retrospective SEER-based analysis, surgery was associated with favorable OS, but the findings are subject to substantial selection bias due to unmeasured confounders (e.g., comorbidities, functional status). Treatment decisions should be individualized based on patient age, tumor size, and clinical symptoms. Future research integrating multicenter clinical data is warranted to advance precision therapy and functional preservation, ultimately improving patient quality of life.