Outcomes in Surgical Management of Sinonasal/Skull Base Tumors: A Single Comprehensive Cancer Center Experience

Introduction: Sinonasal and skull base malignancies are a complex and diverse group. Advances in imaging, knowledge of pathophysiology, endoscopic and open surgical techniques, and chemoradiotherapy, have changed the management paradigms for these tumors over the past 50 years. Our aim was to analyze the outcomes of patients from a single comprehensive cancer center over time and evaluate the impact of associated factors.

Methods: We retrospectively assessed 454 patients with sinonasal malignant tumors treated with surgery at our center between 1973 and 2015. The study was approved by the institutional review board. The Kaplan–Meier method was used to compare outcomes of interest, and a log-rank test was performed to compare the groups. The follow-up interval was calculated in months from the date of initial curative surgery. Several variables including gender, age, pathology, skull base resection, intracranial invasion, tumor site, margins, histology, pT, pN, pM, adjuvant treatment, and a decade of surgery were reviewed to assess the influence on 5 years of OS and DSS. A multivariate analysis of these variables was performed using the Cox proportional hazard regression model. A p-value of less than 0.05 was considered statistically significant.

Results: The median age was 56.7 years (IQR: 46–68). Two hundred eighty-seven were males (63%) and 167 (37%) were females. The majority of tumors were primary 373 (82%). Craniofacial resections were performed in 316 patients (70%). Nasal cavity, ethmoid, and maxillary sinus tumors comprised 85% (386 patients) of all cases. Squamous cell carcinoma was the most prevalent tumor histology 138 patients (30%) followed by melanoma (13%), sarcoma (13%), salivary gland tumors (11%), esthesioneuroblastoma (11%), adenocarcinoma (10%), basal cell carcinoma (1%), and other rare types (11%). Overall (OS), disease-specific survival (DSS) local (LRFP), and regional recurrence-free probability (RRFP) curves for the whole dataset is illustrated in [Fig. 1]. OS and DSS improved with decade of surgery ([Fig. 2]). Patients show statistical significance in pT-stage, surgical margins, orbital invasion, intracranial invasion, and histology groups for OS and DSS (Figs. 3–4). Orbital invasion, pT-stage, pN-stage, and melanoma histology were statistically associated with OS and DSS.

Conclusion: Patients showed improved survival over time with surgery for sinonasal / skull base malignant tumors. This is likely multifactorial with advances in technique and adjuvant treatment as well as improved patient selection for surgery. As has been shown in prior studies patients show a statistically significant difference in pT-stage, surgical margins, orbital invasion, intracranial invasion, and histology groups in overall and disease-specific survival analysis.

Publication History

Article published online:
12 February 2021