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

Abstract

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.

Sinonasal cancers treatments: state of the art

“…Teitelbaum et al [ 6 ▪ ] (3835 patients) showed that patients affected by sinonasal squamous cell carcinoma (SCC) treated in high-volume centers (>16 patients/10 years) had a significantly better prognosis than those treated in low-volume centers (<12 patients/10 years) regardless of age, sex, T category, and treatment schedule. Of note, the majority (55.5%) of patients included in the study received a surgery-including treatment.…”

Surgical Management of Sinonasal Cancers: A Comprehensive Review

“…With the emergence of endoscopic surgery, the treatment of these cancers requires an additional technicality, which due to the rarity of these lesions, can only be acquired in specialized centers. For example, studies performed on the NCDB database have shown that the survival of patients with squamous cell carcinoma of the nasal cavity is increased in the center with a large track record of this type of disease [140] and that centers treating more than two patients per year were associated with a higher rate of clear margins [42]. It has been shown that surgical experience may be associated with increased overall survival and local control in patients treated endoscopically for sinonasal adenocarcinoma [92,141].…”

Need for close interdisciplinary communication after endoscopic endonasal surgery to further personalize postoperative radiotherapy in sinonasal malignancies

“…Orbital preservation best represents the compromise made to achieve acceptable oncological results while maximizing functional outcomes (8). Therefore, sinonasal tumors are indeed an example of multidisciplinarity and should be best performed at high volume centers (9), a statement that of course is challenged by the rarity of these tumors and their variable presentations and histologies.…”