T4 Sinonasal Adenoid Cystic Carcinoma: Overall Survival Differences by Treatment Modality

Objective: Analyze association between treatment and survival in advanced sinonasal adenoid cystic carcinoma (ACC).

Study Design: Retrospective database study.

Setting: University of South Florida Morsani College of Medicine and Icahn School of Medicine at Mount Sinai

Subjects and Methods: The National Cancer Database (NCDB) was queried for patients diagnosed with sinonasal ACC between 2004 and 2010. Patients with metastatic disease, multiple malignant tumors, and follow-up less than one month were excluded.

Results: A total of 568 patients with sinonasal ACC were identified, with an overall 5-year survival of 64.4%. Out of the identified patients, 143 patients presented with T4 primary tumors. 64 patients presented with T4a disease while 79 presented with T4b. There was no significant difference in 5-year overall survival between patients with T4a (55.4%) and T4b tumors (53.8%, p = 0.874; [Fig. 1]). However, patients with stage T4a disease who received surgical therapy had greater 5-year overall survival (72.2%) than those who received non-surgical treatment (14.3%, p < 0.0001). In patients with stage T4b disease, no significant difference in 5-year overall survival was detected between surgical and non-surgical treatment (57.5 vs. 46.3%, p = 0.5981).

Fig. 1 Kaplan–Meier survival estimate curves for stage T4 sinonasal ACC by substage.

Fig. 2 Kaplan–Meier survival estimate curves for stage T4a sinonasal ACC by treatment modality.

Fig. 3 Kaplan–Meier survival estimate curves for stage T4b sinonasal ACC by treatment modality.

Conclusion: Surgical intervention offers significant mortality benefits over non-surgical therapy in patients with T4a sinonasal ACC. Surgery should continue to be recommended as a primary treatment modality for patients with advanced sinonasal ACC who present with stage T4a primary tumors without evidence of distant metastasis.

Publication History

Article published online:
01 February 2023