Evaluation of the Prognostic Capacity of a Novel Survival Marker in Patients with Sinonasal Squamous Cell Carcinoma

Abstract

Sinonasal squamous cell carcinoma (SNSCC) is a malignant tumor associated with poor survival, and easily obtainable prognostic markers are of high interest. Therefore, we aimed to assess the prognostic value of a novel survival index (SI) combining prognostic values of clinical (T and N classifications and invasion across Ohngren's line), inflammatory (neutrophil-to-lymphocyte ratio), and nutritional (albumin and body-mass index) markers. All patients with primarily treated SNSCC between 2002 and 2020 (n = 51) were included. Each of the six SI components was stratified into a low- (0) and high-risk (1) categories. Subsequently, the cohort was stratified into low- (SI of 0-2) and high-risk SI groups (SI of 3-6). Overall survival (OS) and disease-free survival (DFS) were compared between patients with low- and high-risk SI. The log-rank test was used to test for statistical significance. Overall, the mortality rate was 41.2% (n = 21), and the recurrence rate was 43.1% (n = 22). We observed significantly better OS in patients with low-risk SI (n = 24/51, 47.1%, mean OS: 7.9 years, 95% confidence interval (CI): 6.3-9.6 years) than in high-risk SI (n = 27/51, 52.9%, mean OS: 3.4 years, 95% CI: 2.2-4.5 years; p = 0.013). Moreover, we also showed that patients with low-risk SI had a longer DFS than patients with high-risk SI (mean DFS: 6.4, 95% CI: 4.8-8.0 vs. mean DFS: 2.4 years, 95% CI 1.3-3.5, p = 0.012). The SI combines the prognostic capacity of well-established clinical, radiologic, inflammatory, and nutritional prognosticators and showed prognostic potential in our cohort of SNSCC patients.

Keywords: outcome; prognostic marker; sinonasal squamous cell carcinoma; survival; survival index.

Figure 1

A Kaplan–Meier survival curve showing the OS for patients stratified into the low-SI (n = 24, SI 0–2) and high-SI (n = 27, SI 3–6) groups. The mean OS was shorter in the low-risk SI group (mean OS 7.9 years, 95% CI 6.3–9.6 years vs. 3.4 years, 95% CI 2.2–4.5 years). We tested it for statistical significance with the log-rank test, which revealed a significant difference in OS between groups (p = 0.013). OS, overall survival; SI, survival index; CI, confidence interval.

Figure 2

A Kaplan–Meier survival curve showing the DFS for patients stratified into the low-SI (n = 24, SI 0–2) and high-SI (n = 27, SI 3–6) groups. The mean DFS was shorter in the low-risk SI group (mean DFS 6.4 years, 95% CI 4.8–8.0 vs. 2.4 years, 95% CI 1.3–3.5). We tested it for statistical significance with the log-rank test, which revealed a significant difference in OS between groups (p = 0.013). DFS, disease-free survival; SI, survival index; CI, confidence interval.

Figure 3

When stratified for the exact survival index score (0–6), the Kaplan–Meier survival curve shows a significant association between rising survival index and worse overall survival (p < 0.001).

Figure 4

Similar to overall survival, the rising specific survival index score (0–6) was associated with worse disease-free survival. However, the correlation did not reach the level of statistical significance (p = 0.161).