Impact of margin status on survival after surgery for sinonasal squamous cell carcinoma

Abstract

BackgroundSinonasal squamous cell carcinoma (SNSCC) is the most common malignancy of the paranasal sinuses. Surgery is the mainstay of treatment, yet positive surgical margins (PSM) are common and the prognostic impact on overall survival (OS) is mixed. Given the heterogeneity of impact of PSM on OS within the literature, we hypothesized that extent of tumor extirpation (microscopic PSM vs macroscopic PSM) may play a role in OS.MethodsPatients with SNSCC were identified in the National Cancer Database (NCDB, n = 7808). Of these, 4543 patients underwent surgery, 3265 patients underwent nonsurgical therapy. Kaplan‐Meier curves were used to compare OS between negative surgical margin (NSM), micro‐PSM, and macro‐PSM cohorts vs patients undergoing primary nonsurgical therapy in a propensity‐score‒matched analysis. Multivariable analysis of factors associated with macro‐PSM was also performed.ResultsOne thousand thirty‐three (22.0%) of the surgery patients had PSM, and approximately half (n = 521, 50.6%) of these had macro‐PSM. When compared with nonsurgical treatment, propensity‐score‒matched results demonstrated improved OS in patients with NSM and micro‐PSM (p < 0.001), but macro‐PSM patients did not demonstrate improvement (p = 0.20). Tumor within the paranasal sinuses and advanced nodal classification (N2/N3) (odds ratio [OR], 1.18; p = 0.02; and OR, 15.09; p = 005, respectively) was associated with increased odds of macro‐PSM on multivariable analysis.ConclusionWe demonstrate that the degree of tumor extirpation correlates with OS. Macro‐PSM did not confer a benefit to OS when compared with nonsurgical therapy, and factors including tumor location and advanced nodal status affect whether surgery will result in macro‐PSM. Given these findings, informed, shared decisionmaking between patient and surgeon regarding nonsurgical alternatives should occur before electing to proceed with surgery in SNSCC.

Elective neck dissection for T3/T4 cN0 sinonasal squamous cell carcinoma

“…The absence of data on locoregional recurrence within the NCDB renders any explanation for this phenomenon speculative, yet the question warrants consideration. A recent NCDB analysis demonstrated that approximately 30% of SNSCC resections result in positive surgical margins, half of which are grossly positive, attributable to anatomic proximity to the brain and orbit 17 . This has been shown to adversely affect OS 17 .…”

“…A recent NCDB analysis demonstrated that approximately 30% of SNSCC resections result in positive surgical margins, half of which are grossly positive, attributable to anatomic proximity to the brain and orbit 17 . This has been shown to adversely affect OS 17 . One possibility is that the signal of long‐term survival benefit in regional control gained by END is obscured by failure of local control with surgical margin positivity in this subsite.…”

“…17 This has been shown to adversely affect OS. 17 One possibility is that the signal of long-term survival benefit in regional control gained by END is obscured by failure of local control with surgical margin positivity in this subsite.…”

Endoscopic Fluorescence‐Guided Surgery for Sinonasal Cancer Using an Antibody‐Dye Conjugate

“…For sinonasal cancers, complete resection with clear margins significantly impacts oncologic outcomes in patients treated with minimally invasive endoscopic resection. 8,21 Despite the fact that intraoperative frozen margins are reliably interpreted for sinonasal tumors, 22 a clear demarcation of tumor from normal tissue or inflamed polypoid tissues is difficult within the sinonasal cavity. In the current study we demonstrate that endoscopic fluorescence imaging can be sensitive and specific to detect the tumor after systemic administration of a NIR tumor-targeting agent.…”

“…Consequently, rates of positive margins for endoscopic surgery for SNSCC are high (22-30%), which can result in increased local recurrence and decreased survival. 7,8 Fluorescence-guided surgery (FGS) is increasingly being studied as a guide to differentiate tumor tissue from normal tissue in an intraoperative setting. 9 Although several agents are under active clinical study, [10][11][12][13] we investigated the anti-epidermal growth factor receptor (EGFR) antibody-dye conjugate panitumumab-IRDye800CW, which has demonstrated a high sensitivity and specificity of squamous cell carcinoma (SCC) detection in patients with head and neck cancer.…”