Comprehensive staging system for nasopharyngeal angiofibroma: Integrating anatomical and functional parameters

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-08-18 DOI:10.1016/j.ijporl.2025.112524

Anupam Mishra , Subhash Chandra Mishra

{"title":"Comprehensive staging system for nasopharyngeal angiofibroma: Integrating anatomical and functional parameters","authors":"Anupam Mishra , Subhash Chandra Mishra","doi":"10.1016/j.ijporl.2025.112524","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Staging systems for nasopharyngeal angiofibroma (NA) have traditionally shown inconsistencies in anatomical prioritization and have not adequately incorporated functional considerations.</div></div><div><h3>Methods</h3><div>A novel, comprehensive staging system was developed through expert consensus (N = 8) using the Delphi method. This system consists of three components: (1) Composite Anatomical Status (CAS) comprising of tumor extensions in all anterior, posterior, lateral, and superior directions; (2) Composite Symptom Score (CSS) that grades the patient's clinical symptomatology; and (3) Functional Performance Status (FPS) that describes subjective assessment of surgical feasibility based on day to day functional wellbeing. This comprehensive system was retrospectively validated using chart reviews of 145 patients, evaluating demographic data, clinical presentation, and radiological imaging. Six existing staging systems were also applied to this cohort and correlated with CAS, CSS, FPS, and clinical outcomes. This comprehensive staging was further compared with 7 existing classifications.</div></div><div><h3>Results</h3><div>All 7 staging systems demonstrated mutual correlation. CSS significantly correlated with lateral and superior tumor extension, while FPS was associated with anterior extension. Tumor recurrence showed a significant association with lateral extension and the Onerci staging system. CSS effectively reflected advanced disease as identified by CAS, particularly in the lateral and superior extensions. FPS closely paralleled CSS and also showed correlation with anterior extension.</div></div><div><h3>Conclusion</h3><div>The proposed comprehensive staging approach offers a more comprehensive framework for evaluating NA. CAS accurately reflects anatomical progression in all directions, enhancing surgical planning and risk stratification. This integrated staging model overcomes limitations of existing systems not only anatomically but also by unifying it with functional disease assessment.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"197 ","pages":"Article 112524"},"PeriodicalIF":1.3000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of pediatric otorhinolaryngology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0165587625003118","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Staging systems for nasopharyngeal angiofibroma (NA) have traditionally shown inconsistencies in anatomical prioritization and have not adequately incorporated functional considerations.

Methods

A novel, comprehensive staging system was developed through expert consensus (N = 8) using the Delphi method. This system consists of three components: (1) Composite Anatomical Status (CAS) comprising of tumor extensions in all anterior, posterior, lateral, and superior directions; (2) Composite Symptom Score (CSS) that grades the patient's clinical symptomatology; and (3) Functional Performance Status (FPS) that describes subjective assessment of surgical feasibility based on day to day functional wellbeing. This comprehensive system was retrospectively validated using chart reviews of 145 patients, evaluating demographic data, clinical presentation, and radiological imaging. Six existing staging systems were also applied to this cohort and correlated with CAS, CSS, FPS, and clinical outcomes. This comprehensive staging was further compared with 7 existing classifications.

Results

All 7 staging systems demonstrated mutual correlation. CSS significantly correlated with lateral and superior tumor extension, while FPS was associated with anterior extension. Tumor recurrence showed a significant association with lateral extension and the Onerci staging system. CSS effectively reflected advanced disease as identified by CAS, particularly in the lateral and superior extensions. FPS closely paralleled CSS and also showed correlation with anterior extension.

Conclusion

The proposed comprehensive staging approach offers a more comprehensive framework for evaluating NA. CAS accurately reflects anatomical progression in all directions, enhancing surgical planning and risk stratification. This integrated staging model overcomes limitations of existing systems not only anatomically but also by unifying it with functional disease assessment.

查看原文本刊更多论文

鼻咽血管纤维瘤的综合分期系统：整合解剖学和功能参数

鼻咽血管纤维瘤（NA）的分期系统传统上在解剖学优先级上表现出不一致，并且没有充分纳入功能考虑。方法采用德尔菲法，经专家一致意见（N = 8），建立一套新颖、全面的分期体系。该系统由三个部分组成：(1)复合解剖状态（CAS），包括肿瘤在所有前、后、外侧和上方向的扩展；(2)综合症状评分（CSS），对患者的临床症状进行评分；(3)功能表现状态（FPS），描述基于日常功能健康对手术可行性的主观评估。通过对145例患者的图表回顾，评估人口统计数据、临床表现和放射影像，回顾性验证了这一综合系统。六种现有的分期系统也应用于该队列，并与CAS、CSS、FPS和临床结果相关。该综合分期与现有的7种分类进一步比较。结果7个分期系统均表现出相关性。CSS与肿瘤向外侧和上向扩展显著相关，而FPS与肿瘤前向扩展显著相关。肿瘤复发与肿瘤的外侧延伸和Onerci分期系统有显著的相关性。CSS有效地反映了由CAS识别的晚期疾病，特别是侧伸和上伸。FPS与CSS密切相关，也与前伸相关。结论提出的综合分期方法为NA的评估提供了一个更全面的框架。CAS准确反映各方向的解剖进展，加强手术计划和风险分层。这种综合分期模型不仅在解剖学上克服了现有系统的局限性，而且通过将其与功能性疾病评估统一起来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.