Predictive Value of K i-67 Index in Evaluating Sporadic Vestibular Schwannoma Recurrence: Systematic Review and Meta-analysis

Kunal Vakharia, Hirotaka Hasegawa, Christopher Graffeo, Mohammad H.A. Noureldine, Salomon Cohen-Cohen, Avital Perry, Matthew L. Carlson, Colin L.W. Driscoll, Maria Peris-Celda, Jamie J. Van Gompel, Michael J. Link

Research output: Contribution to journalArticlepeer-review


Introduction K i -67 is often used as a proliferation index to evaluate how aggressive a tumor is and its likelihood of recurrence. Vestibular schwannomas (VS) are a unique benign pathology that lends itself well to evaluation with K i -67 as a potential marker for disease recurrence or progression following surgical resection. Methods All English language studies of VSs and K i -67 indices were screened. Studies were considered eligible for inclusion if they reported series of VSs undergoing primary resection without prior irradiation, with outcomes including both recurrence/progression and K i -67 for individual patients. For published studies reporting pooled K i -67 index data without detailed by-patient values, we contacted the authors to request data sharing for the current meta-analysis. Studies reporting a relationship between K i -67 index and clinical outcomes in VS for which detailed patients' outcomes or K i -67 indices could not be obtained were incorporated into the descriptive analysis, but excluded from the formal (i.e., quantitative) meta-analysis. Results A systematic review identified 104 candidate citations of which 12 met inclusion criteria. Six of these studies had accessible patient-specific data. Individual patient data were collected from these studies for calculation of discrete study effect sizes, pooling via random-effects modeling with restricted maximum likelihood, and meta-analysis. The standardized mean difference in K i -67 indices between those with and without recurrence was calculated as 0.79% (95% confidence interval [CI]: 0.28-1.30; p = 0.0026). Conclusion K i -67 index may be higher in VSs that demonstrate recurrence/progression following surgical resection. This may represent a promising means of evaluating tumor recurrence and potential need for early adjuvant therapy for VSs.

Original languageEnglish (US)
Pages (from-to)119-128
Number of pages10
JournalJournal of Neurological Surgery, Part B: Skull Base
Issue number2
StatePublished - Mar 3 2022


  • K -67
  • acoustic neuroma
  • histopathology
  • index
  • meta-analysis
  • progression
  • recurrence
  • systematic review
  • vestibular schwannoma

ASJC Scopus subject areas

  • Clinical Neurology


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