Sinonasal Carcinomas: New Epidemiologic Indicators in Staging, Treatment, and Prognosis

Background: Sinonasal carcinomas (SNCs) are rare and aggressive diseases encompassing a variety of histologies and sites. Previous efforts to characterize these cancers have been hampered by limited evidence due to small retrospective studies series of heterogeneous populations. We have conducted an analysis of the largest series of SNC cases to date, evaluating the impact of various prognostic and treatment-related factors on survival rates.

Methods: Drawing cases from the SEER national cancer database, we examined disease-specific survival (DSS) and overall survival (OS) for SNC on the basis of patient demographics, clinicopathologic factors, tumor histology, and treatment. We also conducted a comparative analysis of separate tumor histologies to identify differences in patient demographics, tumor characteristics, extent of disease, and therapy.

Results: A significant upward trend in the incidence of squamous cell sinonasal carcinomas was observed relative to other SNC histologies after 1998. Significant differences in survival rates were observed based on tumor site and histology, grade and stage, mode of treatment, and race (all P < 0.000). Advanced stage and grade tightly correlated with decreased survival, although the number of positive nodes did not significantly affect survival. DSS for patients undergoing surgery was better than for those receiving combined surgery and radiation therapy or radiation alone (P < 0.000). In terms of DSS, postoperative radiotherapy was superior to preoperative treatment as a general approach to sequential treatment (P = 0.004). DSS for mode of treatment varied with tumor histology: outcomes for squamous cell carcinoma, adenocarcinoma, neuroendocrine carcinoma (all P < 0.000), and lymphoepithelial carcinoma (P = 0.049) were best with surgery alone, whereas DSS for undifferentiated carcinoma was highest with a combination of surgery and radiotherapy (P < 0.000). Salivary glandular carcinoma responded equally well to either combination therapy or surgery alone.

Conclusion: Analysis of the largest SNC series to date has revealed that separate histopathologic subtypes display unique behaviors, demographic and anatomic distributions, and patterns of response to therapy, with surgical intervention generally providing the best outcomes.