How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis

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.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Dennis Parhar.

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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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Keywords

  • Neuroblastoma
  • Image
  • Risk factor
  • IDRF
  • Complication
  • Survival