Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
J Neurooncol. 2021 May;153(1):15-22. doi: 10.1007/s11060-021-03746-2. Epub 2021 Mar 26.
Esthesioneuroblastoma (ENB) is an uncommon primary sinonasal tumor which can extend intracranially. Exactly how to classify them pathologically still remains discrepant; the Hyams grading system, for example, has not been universally adopted. This individual patient data (IPD) meta-analysis aimed to investigate the prognostic implication of each Hyams grade on patient outcomes.
We accessed two electronic databases including PubMed and Web of Science. Raw patient data from potential articles were extracted. To examine the associations of various clinicopathological factors with the Hyams grades, we utilized Chi-square, t-test, and Mann-Whitney, as appropriate. Log-rank test and Cox regression analysis were used to elucidate the impact of the Hyams grades on recurrence-free survival (RFS), metastasis-free survival (MFS), and overall survival (OS) of ENB patients.
We included 33 studies with 492 ENB patients. We found significant associations of Kadish stages, Dulguerov stages, rates of recurrence, metastasis, and patient mortality with Hyams grade. Log-rank tests and Cox regression models demonstrated significant differences in RFS and OS of Hyams grade I - II, grade III, and grade IV patients. There was no statistical difference in RFS and OS of Hyams grade I and II. Radiotherapy was only effective in grade III - IV ENBs and chemotherapy showed no benefits to patients.
We verify that the Hyams grading system appears to be a reliable prognostic indicator to assess ENB patient outcomes. Consolidating the Hyams grading system into a three-tier system based on similar clinical outcomes of grades I and II may simplify this classification schema.
嗅神经母细胞瘤（ENB）是一种罕见的原发于鼻腔鼻窦的肿瘤，可向颅内扩展。病理上如何对其进行分类仍存在差异；例如，Hyams 分级系统并未被普遍采用。本项个体患者数据（IPD）荟萃分析旨在探讨每个 Hyams 分级对患者预后的预测意义。
我们检索了包括 PubMed 和 Web of Science 在内的两个电子数据库。从潜在文章中提取原始患者数据。为了研究各种临床病理因素与 Hyams 分级的相关性，我们分别采用卡方检验、t 检验和 Mann-Whitney 检验。Log-rank 检验和 Cox 回归分析用于阐明 Hyams 分级对 ENB 患者无复发生存（RFS）、无转移生存（MFS）和总生存（OS）的影响。
我们纳入了 33 项研究，共纳入 492 例 ENB 患者。我们发现 Kadish 分期、Dulguerov 分期、复发率、转移率和患者死亡率与 Hyams 分级显著相关。Log-rank 检验和 Cox 回归模型显示，Hyams 分级 I- II 级、III 级和 IV 级患者的 RFS 和 OS 存在显著差异。Hyams 分级 I 级和 II 级患者的 RFS 和 OS 无统计学差异。放疗仅对 III-IV 级 ENB 有效，化疗对患者无益。
我们证实 Hyams 分级系统似乎是评估 ENB 患者预后的可靠预后指标。根据相似的临床结局，将 Hyams 分级系统整合为一个三级系统可能会简化这种分类方案。
