Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Torabi, Sina J.; Spock, Todd; Cardoso, Bruno; Chao, Janet Ren; Morse, Elliot; Manes, R. Peter; Judson, Benjamin L.

doi:10.1002/lary.28315

Cited by 34 publications

(46 citation statements)

References 47 publications

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“…We found a significantly high rate of positive margins (>40%) and they were broadly associated with increased mortality, similar to other HN malignancies 51,52 . However, as discussed, this varied by histology.…”

Section: Discussionsupporting

confidence: 83%

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

et al. 2020

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The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors. Methods: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016). Results: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]). Conclusion: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.

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Section: Discussionsupporting

confidence: 83%

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

et al. 2020

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“…In a study by Torabi et al, looking at SNSCC margin status, there was a statistically significant difference between high- and low-volume facilities in achieving negative margins. 32 However, they defined high-volume facilities as having ≥2 cases per year instead of a tertile grouping and excluded nonsurgical cases when tabulating facility case volume. Studies in laryngeal surgery and transoral robotic surgery have demonstrated improved negative margin rates at high-volume facilities.…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High‐Volume Center Confer Survival Benefit?

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et al. 2020

Otolaryngol.--head neck surg.

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Objective To determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high-volume facility affects survival. Study Design Retrospective database analysis. Setting National Cancer Database (2004-2014). Subjects and Methods The National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case-specific volume—averaged per year and grouped in tertiles as low (0%-33%), medium (34%-66%), and high (67%-100%)—were compared. Overall survival was compared with Cox proportional hazards regression analysis. Results A total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P < .001; 95% CI, 0.63-0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. Univariate analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR, 0.77; P = .002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high-volume facility (HR, 0.81; P < .001) had significantly improved survival. Conclusion This study shows a better overall survival for sinonasal SCC treated at high-volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.

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“…This finding is consistent with prior studies where SCC patients with positive margins had a decreased OS and required additional use of adjuvant therapies. 23 Some advocate treating advanced-stage PDSCC with induction chemotherapy using taxane and platinumbased agents or taxanes and 5-fluorouracil followed by definitive CRT or neoadjuvant chemotherapy followed by surgery and adjuvant CRT. 24,25 In our study, we did not find evidence of a survival benefit with the use of induction, neoadjuvant, or adjuvant chemotherapy within the treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Sinonasal Poorly Differentiated Squamous Cell Carcinoma

et al. 2020

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Objective: Sinonasal squamous cell carcinoma (SCC) is rare with no consensus on treatment regimen. Our goal is to analyze treatment outcomes in poorly differentiated SCC (PDSCC) using a large national database. Study Design: Retrospective database study. Methods: The National Cancer Database was queried for sinonasal invasive SCC, grade 3 (poorly differentiated) from 2004 to 2014. Patient demographics and tumor and treatment characteristics were tabulated. Kaplan-Meier (KM) analysis was performed to compare overall survival (OS) between histology subtype and primary site. Multivariable Cox proportional hazards regression was performed for statistical analysis of treatment regimen on OS. Results: A total of 1,074 patients were identified. The maxillary sinus was the most common site (45%). T4 tumors were observed in 50% of patients, with most patients treated at high-volume facilities (77%). In KM analysis, spindle cell SCC histological subtype, primary tumors of the maxillary sinus, and poorly differentiated grade had worse OS. In our Cox-PH model, higher T stage and age were associated with worse OS. Those treated at a high-volume facility and those who underwent surgical resection followed by adjuvant radiation had improved OS. Chemotherapy within the treatment regimen did not confer survival benefit except in surgical patients when positive margins were present, and surgery with adjuvant chemoradiation trended toward improved survival. Conclusions: Sinonasal PDSCC appears to be best treated at high-volume centers with surgical resection followed by adjuvant radiation. Poorly differentiated grade has worse OS compared to more differentiated tumors. Chemotherapy along with adjuvant radiation may have a role in patients with positive surgical margins.

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Margins in Sinonasal Squamous Cell Carcinoma: Predictors, Outcomes, and the Endoscopic Approach

Cited by 34 publications

References 47 publications

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High‐Volume Center Confer Survival Benefit?

Survival Outcomes in Sinonasal Poorly Differentiated Squamous Cell Carcinoma

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