Sinonasal malignancies: Histopathological entities, regional involvement and long-term outcome

Abstract

Background To assess a large patient cohort with sinonasal malignancies focusing on regional involvement, recurrence and oncological outcome. Methods Patients (n = 144) with malignant tumors of the nasal cavity and paranasal sinuses were treated at our tertiary referral center between 2008 and 2019. A chart review on patient and tumor characteristics, treatment and long-term outcome was performed. Results Most frequent histological types were squamous cell carcinoma (SCC) (n = 74), adenocarcinoma (n = 24) and mucosal melanoma (n = 18). Primary therapy was surgery in 66% of patients (n = 95) of which 65.8% (n = 66) received adjuvant radiotherapy. Twenty patients (13.8%) were initially staged as cN + and in seven cases, pN + status was histopathologically confirmed. Fifty-six of 130 patients (43.1%) had a relapse after curative intended therapy, including nine loco-regional (6.9%) and seven isolated regional recurrences (5.4%). Twelve of these 16 patients with (loco-)regional recurrence had SCC. Adenoid cystic carcinoma (87.5%) and SCC (65.3%) showed the best long-term overall survival. Conclusions Regional involvement and regional recurrence are scarce. Because of rarity and heterogeneity, evidence on therapeutic management is sparse resulting in the lack of clinical guidelines. Graphical Abstract

Survival of Patients with Sinonasal Cancers in a Population-Based Registry, Lombardy, Italy, 2008–2023

“…The SNC incidence rate is below 1–2 per 100,000 person-years and more frequent (roughly double) in men [ 3 , 4 , 5 , 6 , 7 ]. The most frequently affected anatomical sites are the nasal cavity and the maxillary and ethmoidal sinuses [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. The majority of SNCs (80%) are epithelial; the most frequent morphologies are squamous cell carcinoma (SCC), mostly in the maxillary sinus and nasal cavity, and intestinal-type adenocarcinoma (ITAC), which often arises in the ethmoidal sinus [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…Overall 5-year survival after SNC diagnosis is widely variable, depending on the cancer site, stage, histological type, and treatment [ 3 , 4 , 5 , 8 , 9 , 10 ]. Tumours with good/moderate histologic differentiation present a survival advantage over the poorly differentiated ones [ 8 ]. Because of the anatomic location, SNCs often have an unspecific onset of symptoms and are diagnosed at a late stage.…”

“…SNCs deserve a multidisciplinary approach in a tertiary centre (with a high volume of head and neck patients treated). Because of the rarity and morphological heterogeneity, evidence on therapeutic management is sparse, resulting in a lack of clinical guidelines [ 8 ].…”