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. 2025 Aug 26.
doi: 10.1002/lary.70044. Online ahead of print.

Prognostic Factors in Sinonasal Cancers: A Multicenter Pooled Analysis

Milica Stefanovic  1 , Alberto Hernando-Calvo  2 , Jesus Brenes Castro  3 , Shao Hui Huang  4 , Jie Su  5 , Brian O'Sullivan  4 , Jolie Ringash  4   6 , Isabel Linares Galiana  1 , Alicia Lozano Borbalas  1 , Beatriz Cirauqui Cirauqui  7 , Ezra Hahn  4 , Iris Teruel  7 , John R de Almeida  6 , Jordi Marruecos Querol  8 , Ian J Witterick  6 , Jordi Rubió-Casadevall  9 , David Paul Goldstein  6 , Lillian L Siu  2 , John Waldron  4 , Marc Oliva  3 , Anna Spreafico  2
Affiliations

Prognostic Factors in Sinonasal Cancers: A Multicenter Pooled Analysis

Milica Stefanovic et al. Laryngoscope. .

Abstract

Objectives: Sinonasal cancers (SNC) are heterogeneous diseases with different clinical behavior. We aimed to identify prognostic factors in non-metastatic (M0)-SNC.

Methods: Electronic health records from M0-SNC patients treated with definitive surgery ± postoperative radiotherapy or chemoradiotherapy at two tertiary institutions were reviewed. p16 staining was performed in the squamous cell carcinoma (SCC) subset. Multivariable analysis (MVA) calculated the adjusted hazard ratio (aHR) for histology type (SCC as the comparator), T/N categories, and primary treatment modality for the risk of locoregional failure (LRF), distant metastasis (DM), and deaths.

Results: A total of 376 patients were eligible including 209 (56%) SCC (p16+: 35; p16-/untested: 157), 42 (11%) adenocarcinoma, 35 (9%) sinonasal undifferentiated carcinoma or sinonasal neuroendocrine tumors (SNUC/SNEC), 33 (9%) mucosal melanoma (MM), 30 (8%) esthesioneuroblastoma (ES), and 27 (7%) adenoid cystic carcinoma (ACC). MVA identified MM histology (aHR 2.03, 95% CI 21.23-3.33), older age (aHR 1.02; 95% CI: 1.00-1.03), T3-4 tumor (aHR 5.08, 95% CI 2.77-9.30), and nodal involvement (aHR: 2.15, 95% CI 1.46-3.16) carried higher mortality risk (all p < 0.05); MM (aHR 10.14, 95% CI 4.90-21.01), ACC (aHR 2.97, 95% CI 1.27-6.96), and SNUC/SNEC (aHR 6.80, 95% CI 3.30-14.01) histologies and T3-4 categories (vs. T1-2, HR 4.79, 95% CI 1.53-14.95) had higher DM risk; T3-4 (aHR 2.33, 95% CI 1.37-3.97) and nodal involvement (aHR 1.70, 95% CI 1.11-2.60) conveyed higher LRF risk while SNUC/SNEC histologies had a lower LRF risk (aHR 0.51, 95% CI 0.26-3.33).

Conclusions: Different SNC histology types exhibit distinct patterns of relapse and survival, highlighting the need for different management strategies.

Keywords: chemotherapy; head and neck cancer treatment; radiotherapy; sinonasal cancer; squamous cell carcinoma; trimodality treatment.

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