Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta‐analysis

Abstract

Objective To compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease-free (DFS) and overall survival (OS). Data Sources Systematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases. Review Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta-analysis. Results Pooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS ( P < .05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS ( P < .05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23). Conclusion This study represents the first IPD meta-analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.

Long‐term oncologic outcomes in esthesioneuroblastoma: An institutional experience of 143 patients

“…In rare cases, induction CT may be indicated before definitive therapy 5 . Historically, open craniofacial approaches were utilized; however, over the past 2 decades there has been a shift towards endoscopic approaches with comparable oncologic outcomes demonstrated in appropriately selected patients 1,3,7 …”

“…1,3,7 Multiple staging systems have been proposed to provide prognostic information and guide treatment decisions; however, no system has been universally accepted, and the generalizability of staging systems derived from single institutional experiences has been questioned. 1,3 Surveillance Epidemiology and End Results (SEER) database studies have demonstrated that modified Kadish (mKadish) staging, lymph node involvement, and age at diagnosis are significant prognostic factors. Hyams grade, a pathologic grading system, has also been utilized to determine prognosis and outcomes in these patients.…”

“…Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the olfactory epithelium of the cribriform plate with an incidence rate of 0.4 cases per 1,000,000, representing 2% to 6% of all sinonasal malignancies. 1,2 Because of the relatively asymptomatic, insidious growth pattern, these tumors can be locally aggressive, invading the adjacent orbit or intracranial contents. 3 Surgical resection is the mainstay of treatment, with consideration for adjuvant radiation therapy (RT) with or without chemotherapy (CT).…”

“…5 Historically, open craniofacial approaches were utilized; however, over the past 2 decades there has been a shift towards endoscopic approaches with comparable oncologic outcomes demonstrated in appropriately selected patients. 1,3,7 Multiple staging systems have been proposed to provide prognostic information and guide treatment decisions; however, no system has been universally accepted, and the generalizability of staging systems derived from single institutional experiences has been questioned. 1,3 Surveillance Epidemiology and End Results (SEER) database studies have demonstrated that modified Kadish (mKadish) staging, lymph node involvement, and age at diagnosis are significant prognostic factors.…”

Survival Impact of Postoperative Radiotherapy in Patients with Olfactory Neuroblastoma ： 513 Cases from the SEER Database

“…Presently, there is no uniform staging standard for ONB. The modi ed Kadish staging system proposed by Morita and his colleagues [6] has been shown to be related to prognosis and used to guide tumor management and treatment [7]. It is used in many studies to classify ONB [8].…”