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.
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Abbreviations
- IDRF:
-
Image-defined risk factor
- INRG:
-
International neuroblastoma risk group
- INRGSS:
-
International neuroblastoma risk group staging system
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Acknowledgements
We would like to thank Michael Stoto, Ph.D. for his assistance in developing and reviewing our search strategy.
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Appendix A: search strategy
Appendix A: search strategy
(“Neuroblastoma” [mesh] OR “Neuroblastoma/diagnosis” [mesh] OR “Neuroblastoma/complications” [mesh] OR “Neuroblastoma/pathology” [mesh] OR “Neuroblastoma/surgery” [mesh]).
AND
(“Risk factors” [mesh] OR “image-defined risk factors” [tiab] OR “image defined risk factors” [tiab] OR IDRF [tiab] OR “Neoplasm staging” [mesh] OR staging [tiab] OR stage [tiab]).
AND
“Humans” [mesh].
NOT
(“esthesioneuroblastoma, olfactory” [mesh] OR “case reports” [pt]).
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Parhar, D., Joharifard, S., Lo, A.C. et al. How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis. Pediatr Surg Int 36, 897–907 (2020). https://doi.org/10.1007/s00383-020-04696-y
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DOI: https://doi.org/10.1007/s00383-020-04696-y