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Review
. 2019 Sep;9(9):1054-1062.
doi: 10.1002/alr.22373. Epub 2019 Jun 28.

Hyams grading as a predictor of metastasis and overall survival in esthesioneuroblastoma: a meta-analysis

Khodayar Goshtasbi  1 , Arash Abiri  1 , Mehdi Abouzari  1 , Ronald Sahyouni  1 , Beverly Y Wang  2 , Bobby A Tajudeen  3 , Frank P K Hsu  4 , Gilbert Cadena  4 , Edward C Kuan  1
Affiliations
Review

Hyams grading as a predictor of metastasis and overall survival in esthesioneuroblastoma: a meta-analysis

Khodayar Goshtasbi et al. Int Forum Allergy Rhinol. 2019 Sep.

Abstract

Background: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor.

Methods: A systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates.

Results: Of the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively.

Conclusion: HGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.

Keywords: esthesioneuroblastoma; meta-analysis; metastasis; olfactory neuroblastoma; survival.

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Conflict of interest statement

Conflict of Interest: None

Figures

FIGURE 1.
FIGURE 1.
Flowchart of study inclusion.
FIGURE 2.
FIGURE 2.
Forrest Plots demonstrating an overall 2.08 (p=0.03) and 2.37 (p=0.03) ORs for ENB neck metastasis and distant metastasis, respectively. Lines are representative of the 95% confidence interval and boxes represent the post-operative intervention rate. Each box’s size correlates to that study’s size effect.
FIGURE 3.
FIGURE 3.
Forrest Plots demonstrating an overall 3.39 (p<0.001) and 3.03 (p<0.001) ORs for ENB 5- and 10-year overall survival, respectively. Lines are representative of the 95% confidence interval and boxes represent the post-operative intervention rate. Each box’s size correlates to that study’s size effect.
FIGURE 4.
FIGURE 4.
Funnel plots of the four outcome variables for the evaluation of study bias. Dotted lines represent 95% confidence interval with a fixed population treatment effect, and the presence of a study outside these boundaries may suggest systematic bias. The only studies falling outside the boundaries were Malouf et al. and Su et al. distant metastasis and 5-year survival data, respectively.
See this image and copyright information in PMC

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