Prognostic Factors and Outcomes of De Novo Sinonasal Squamous Cell Carcinoma: A Systematic Review and Meta‐analysis

Abstract

Objective To review overall survival (OS), recurrence patterns, and prognostic factors of de novo sinonasal squamous cell carcinoma (DN-SCC). Data Sources PubMed, Scopus, OVID Medline, and Cochrane databases from 2006 to December 23, 2020. Review Methods The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles were required to report either recurrence patterns or survival outcomes of adults with DN-SCC. Case reports, books, reviews, meta-analyses, and database studies were all excluded. Results Forty-one studies reported on survival or recurrence outcomes. The aggregate 5-year OS was 54.5% (range, 18%-75%) from 35 studies (n = 1903). Patients undergoing open surgery were more likely to receive radiation therapy and present at an advanced stage compared to those receiving endoscopic surgery (all P < .001). Advanced T stage, presence of cervical nodal metastases, maxillary sinus primary site, and negative human papillomavirus (HPV) status were all correlated with significantly worse 5-year OS. Direct meta-analysis of 8 studies demonstrated patients with surgery were more likely to be alive at 5 years compared to those who did not receive surgery (odds ratio, 2.26; 95% CI, 1.48-3.47; P < .001). Recurrence was reported in 628 of 1471 patients from 26 studies (42.7%) with an aggregate 5-year locoregional control rate of 67.1% (range, 50.4%-93.3%). Conclusion This systematic review and meta-analysis suggests that the 5-year OS rate for DN-SCC may approach 54.5% and recurrence rate approaches 42.7%. In addition, various tumor characteristics including advanced T stage, positive nodal status, maxillary sinus origin, and negative HPV status are all associated with decreased survival.

Recurrence rates of de-novo versus inverted papilloma-transformed sinonasal squamous cell carcinoma: a meta-analysis

“…Similarly, a systematic review of 41 studies reported 55% 5-year OS and 43% recurrence in patients with DN-SCC (6) . The apparent survival and recurrence differences in these reviews provides evidence for DN-SCC and IP-SCC being distinct entities, though survival outcomes between DN-SCC and IP-SCC had not been directly compared through a systematic review and meta-analysis until recently (4,(7)(8)(9)(10)(11)(12)(13)(14) .…”

“…Previously, we have reported survival and recurrence outcomes of both IP-SCC and DN-SCC alone as systematic reviews. The systematic review on DN-SCC included 43 studies and reported aggregate survival and recurrence information (6) . The systematic review on IP-SCC included 28 studies with reporting of similar outcomes measures (5) .…”

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Nonetheless, HPV infection appears to play an etiologic role in approximately 25% of SNSCC. It is proposed that HPV‐associated SNSCC confers an improved prognosis 1062,1063 . Similarly, EBV has been detected in SNSCC.…”

“…Additionally, though cervical lymph node metastasis is uncommon overall for SNSCC, a maxillary site of origin is much more likely to present with nodal metastasis than nasoethmoidal SNSCC. Cervical metastases, when present, confer worse prognosis 231,1063 …”

“…Despite advances in multimodality therapy and evidence for survival benefit with treatment at high volume centers, the overall prognosis is still poor 1080 . In a recent meta‐analysis of 41 studies reporting on outcomes of SNSCC, the aggregate 5‐year OS was 54.5% with a recurrence rate of 42.7% and an aggregative 5‐year LRC rate of 42.7% 1063 . Despite this, emerging therapies and better understanding of tumor biology may shift treatment paradigms and improve long‐term oncologic outcomes.…”