PhD Scientific Days 2023

Translational Medicine III.

Predicting residual cholesteatoma with the Potsic staging system

Text of the abstract

Introduction: The most widely used staging system for congenital cholesteatoma is the one described by Potsic and colleagues in 2002, wherein stage is based on the extension of the disease. The real prognostic value of this system in estimating the occurrence of residual disease still remains uncertain. To create a higher level of evidence concerning the usefulness of the Potsic staging system, a joint data analysis of these studies was needed.
Aims: To assess whether the Potsic staging system was indeed indicative of the rate of residual disease, and if the extent of hearing improvement was also connected to stage at presentation.
Methods: A protocol registration was published on PROSPERO, in which residual disease was described as a primary outcome and hearing improvement as secondary. After conducting a systematic search in four databases (PubMed, Cochrane Library, Embase, Web of Science) on December 14, 2022, a total of 3,794 individual records were identified in which outcomes were documented according to Potsic stage after primary surgery in patients of all ages and sexes. Publications without documented follow-up were excluded. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used, and the between-study heterogeneity was assessed by I2.
Result: A total of 13 articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies. Regarding the proportions of residual disease, analysis using the χ2 test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I: 0.66 (Confidence Interval (CI): 0.01-0.33); stage II: 0.20 (CI:0.09-0.38); stage III: 0.06 (CI:0.00-0.61); stage IV: 0.17 (CI:0.01-0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published.
Conclusion: No statistically significant difference was found in the proportions of residual disease between Potsic stages after follow-up for at least one year.
Funding: Funding was provided by Semmelweis University’s Centre for Translational Medicine.