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

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

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.

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.

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.