Conditional and Overall Disease-Specific Survival in Patients With Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the Endoscopic Era

Abstract

Background The management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000. Methods Patients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage. Results We analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P < .001) after controlling for age and stage. After stratifying by stage, diagnosis after year 2000 was associated with improved DSS for localized (HR:0.71, 0.59-0.86, P < .001) malignancies, regional (HR: 0.86, 0.78-0.94, P = .001) and distant malignancies (HR 0.74, 0.63-0.87, P < .001). CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer, and those diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000. Descriptively, the association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers, but was consistent for other stages. Conclusion For paranasal sinus and nasal cavity malignancies, year of diagnosis independently influences both DSS and CDSS. Improved survival is likely due to advances in both surgical and adjuvant treatments. To our knowledge, this study is the first to examine CDSS for these malignancies.

The contemporary management of cancers of the sinonasal tract in adults

“…The median age was 64 years at diagnosis. The widespread use of nasal endoscopy and radiologic studies may have allowed earlier diagnosis, leading to improved survival 2 …”

“…Sinonasal malignancies make up <5% of all head and neck neoplasms, with an incidence of 0.556 per 100,000 individuals per year 1 . While outcomes of other cancers of the head and neck have significantly improved over the past decade, the outcomes of sinonasal malignancies have been relatively stable 2 . This is likely related, at least in part, to the exclusion of sinonasal malignancies from most clinical studies that have tested therapeutic agents for patients with head and neck cancer 3 .…”

Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management

“…[3][4][5][6] Studies have suggested that endoscopic approaches are associated with improved subjective and objective outcomes for these conditions. [7][8][9][10] Complications of EES are generally rare, with some studies reporting major complication rates of 1% and lower. [11][12][13] However, adverse events have been reported, with one of the most common complications being hemorrhage and hematoma formation.…”

“… 3 , 4 , 5 , 6 Studies have suggested that endoscopic approaches are associated with improved subjective and objective outcomes for these conditions. 7 , 8 , 9 , 10 …”

Reflecting on the Work of the Giants That Come Before You

“…14,15 Sinonasal malignancies continue to plague patients during the pandemic and Sharma et al, discuss the improvements in outcomes as endoscopic resections of sinonasal cancers have become more accepted as an appropriate treatment modality. 16 Meerwein et al, examine whether or not treatment of the nodal drainage basins of the sinonasal cavity affect treatment outcomes and survival 17 , and Wang et al, are examining heat shock proteins as a marker for Juvenile Nasopharyngeal Angiofibromas. 18 Olfactory dysfunction has taken a far more prominent place in the minds of North Americans as many afflicted with Covid-19 have experienced this directly.…”