Analysis of the Treatment and Survival of Sinonasal Extramedullary Plasmacytoma

Abstract

Background While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series. Objective To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP. Methods The National Cancer Database was queried for all patients with SN-EMP between 2004–2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival. Results The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone. Conclusion In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival.

Extramedullary Plasmacytoma of the Maxillary Sinuses in a Patient With Multiple Myeloma

“…Both options significantly outperformed chemotherapy alone or combination radiotherapy and chemotherapy. 5 …”

Sinonasal lymphoma: A primer for otolaryngologists

“…Recent studies have demonstrated improved survival with surgical resection of solitary lesions of SN-EMP in conjunction with radiation therapy compared to single modality or non-surgical therapies. [104][105][106][107] No consensus has been established on the optimal treatment plan for SN-DLBCL, though patients who receive chemoradiation demonstrate improved overall survival relative to patients who receive multiagent chemotherapy or radiation alone. 24,36,[108][109][110] Addition of immunotherapy may further enhance treatment regimens that already include multi-agent chemoradiotherapy with improved progressionfree and overall survival.…”

“…Although not classified as a SN‐NHL subtype, SN‐EMP develops from B‐cell differentiation into plasma cells with derangements in plasmacytic differentiation. Recent studies have demonstrated improved survival with surgical resection of solitary lesions of SN‐EMP in conjunction with radiation therapy compared to single modality or non‐surgical therapies 104–107 …”

“…Recent studies have demonstrated improved survival with surgical resection of solitary lesions of SN‐EMP in conjunction with radiation therapy compared to single modality or non‐surgical therapies. 104 , 105 , 106 , 107 …”

Rhinologic Innovation and Advancement Come in All Forms of Investigation

“…Finally, Gao et al performed univariate and multivariate analyses on treatment and survival of sinonasal extramedullary plasmacytoma through the National Cancer Database. 10 They found that patients with this pathology have an overall 5-year survival of 74% with decreased survival associated with the frontal sinus as primary site as well as age greater than 60.…”