Dennis Parhar1, Shahrzad Joharifard2, Andrea C Lo3,4, Mary-Pat Schlosser5, Oluwatomilayo O Daodu6. 1. Department of Radiology, University of British Columbia, Gordon & Leslie Diamond Health Centre, 11th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. parhar@alumni.ubc.ca. 2. Departément de Chirurgie, Division de Chirurgie Pédiatrique, Université de Montréal, Montréal, QC, Canada. 3. Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada. 4. Department of Surgery, University of British Columbia, Vancouver, BC, Canada. 5. Department of Pediatric Medicine, Division of Immunology, Hematology/Oncology, Palliative Care and Environmental Medicine, University of Alberta, Edmonton, AB, Canada. 6. Department of Surgery, Division of Pediatric Surgery, University of Calgary, Calgary, AB, Canada.
Abstract
INTRODUCTION: Since their introduction to the International Neuroblastoma Risk Group (INRG) staging system in 2009, the role of Image-Defined Risk Factors (IDRFs) in predicting outcomes has been studied in heterogeneous populations with varying results. We conducted a systematic review and meta-analysis in order to determine quantitative measures of precisely how well pre-treatment IDRFs predict surgical outcomes and survival. METHODS: A systematic review was performed for studies between January 1990 and July 2019 that compared surgical outcomes and/or survival in pediatric neuroblastoma patients with one or more IDRFs to patients without IDRFs. Summary risk ratios (RR) and hazard ratios (HR) were calculated using a random-effects model. RESULTS: 19 retrospective cohort studies were included, representing data from 1132 patients. The risk ratio (RR) of incomplete surgical resection in IDRF-positive patients compared to IDRF-negative patients was 2.45 (95% CI 1.51-3.97). The RR of surgical complications was 2.30 (95% CI 1.46-3.61). The hazard ratio (HR) for 5-year EFS was 2.08 (95% CI 2.93-4.13) while the 5-year HR for OS was 2.44 (95% CI 1.46-4.08). CONCLUSION: IDRF-positive neuroblastoma patients have a higher risk of incomplete surgical resection, surgical complications, and 5-year mortality and/or relapse. Our results affirm that IDRFs remain a useful prognostic tool for neuroblastoma patients both for short and long-term outcomes. LEVEL OF EVIDENCE: II.
INTRODUCTION: Since their introduction to the International Neuroblastoma Risk Group (INRG) staging system in 2009, the role of Image-Defined Risk Factors (IDRFs) in predicting outcomes has been studied in heterogeneous populations with varying results. We conducted a systematic review and meta-analysis in order to determine quantitative measures of precisely how well pre-treatment IDRFs predict surgical outcomes and survival. METHODS: A systematic review was performed for studies between January 1990 and July 2019 that compared surgical outcomes and/or survival in pediatric neuroblastomapatients with one or more IDRFs to patients without IDRFs. Summary risk ratios (RR) and hazard ratios (HR) were calculated using a random-effects model. RESULTS: 19 retrospective cohort studies were included, representing data from 1132 patients. The risk ratio (RR) of incomplete surgical resection in IDRF-positive patients compared to IDRF-negative patients was 2.45 (95% CI 1.51-3.97). The RR of surgical complications was 2.30 (95% CI 1.46-3.61). The hazard ratio (HR) for 5-year EFS was 2.08 (95% CI 2.93-4.13) while the 5-year HR for OS was 2.44 (95% CI 1.46-4.08). CONCLUSION: IDRF-positive neuroblastomapatients have a higher risk of incomplete surgical resection, surgical complications, and 5-year mortality and/or relapse. Our results affirm that IDRFs remain a useful prognostic tool for neuroblastomapatients both for short and long-term outcomes. LEVEL OF EVIDENCE: II.
Authors: Patrycja Sosnowska-Sienkiewicz; Danuta Januszkiewicz-Lewandowska; Przemysław Mańkowski Journal: Int J Environ Res Public Health Date: 2021-02-14 Impact factor: 3.390