ArticleJournal of neuro-oncology2026
Blood immune profiling predicts surgical anatomy and facial nerve outcome in Vestibular Schwannoma.
Article in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSurgical resection of vestibular schwannoma (VS) is frequently complicated by unpredictable tumor fibrosis and adhesion to the facial nerve and brainstem, yet validated preoperative blood-based biomarkers for these intraoperative features are lacking. We tested whether peripheral blood immune profiles predict the intraoperative surgical anatomy of VS.
methodsIn a retrospective cohort of 342 VS patients undergoing microsurgical resection via the retrosigmoid approach, high-dimensional peripheral blood flow cytometry quantified T, B, and NK cell subsets, memory/activation status, and PD-1 exhaustion markers, alongside routine hematological parameters. Multivariable logistic regression models adjusted for age, sex, and tumor size were constructed for four endpoints: tumor texture, facial nerve adhesion, brainstem adhesion, and postoperative facial nerve function.
resultsEach 1-SD increase in central memory CD8+ T-cell (Tcm CD8+) levels was associated with lower odds of hard, fibrotic tumor texture (OR = 0.68, 95% CI 0.52-0.88, p = 0.004). Brainstem adhesion was associated with elevated NK cells (OR = 1.50, p = 0.023), whereas each 1-SD increase in Tcm CD8+ levels was associated with lower odds of adhesion (OR = 0.64, p = 0.018), yielding an apparent AUC of 0.80 (bootstrap-corrected 0.76). Severe facial nerve adhesion was associated with elevated platelets (OR = 1.59, p = 0.021), whereas each 1-SD increase in TEMRA CD4+ levels was associated with lower odds of severe adhesion (OR = 0.56, p = 0.006). Higher preoperative CD8+ T-cell levels were associated with lower odds of poor facial nerve function (OR = 0.58, p = 0.015). A combined NK-Tcm CD8+ risk score stratified brainstem adhesion from 8.8% to 24.6% across three tiers (P_trend = 0.002), with adequate model calibration (Hosmer-Lemeshow p = 0.795).
conclusionSystemic immune profiles were associated with VS surgical anatomy and postoperative facial nerve outcome. These exploratory biomarkers require prospective external validation before they can be considered for clinical risk stratification.
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