How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis
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In brief
In brief
This meta-analysis of 1,132 neuroblastoma patients demonstrates that image-defined risk factors (IDRFs) significantly predict surgical and survival outcomes. IDRF-positive patients show 2.45× higher risk of incomplete resection, 2.30× higher surgical complications, and worse 5-year survival, confirming IDRFs as valuable prognostic tools in the INRG staging system.
Written by the GCMD Library team from the article.
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.