Survival Outcomes of De Novo vs Inverted Papilloma–Associated Sinonasal Squamous Cell Carcinoma

Abstract

IMPORTANCE Overall, the prognosis of sinonasal squamous cell carcinoma (SCC) is poor. This malignancy can arise de novo or from inverted papillomas, but it is unclear whether survival differences between the 2 pathologies exist.OBJECTIVE To assess for survival differences between patients with sinonasal de novo SCC (dnSCC) and those with inverted papilloma-associated SCC (IPSCC).DATA SOURCES A search of Ovid MEDLINE, Embase, Scopus, and the Cochrane Library from inception to January 23, 2020, with cross-referencing of retrieved studies, was performed. Additional data were requested from authors.STUDY SELECTION Inclusion and exclusion criteria were designed to capture studies with survival outcomes of adults with sinonasal SCC who underwent regular treatment. Clinical trials, cohort studies, case-control studies, and case series with more than 10 adults aged 18 years or older with sinonasal SCC were included. Exclusion criteria were studies on non-SCC sinonasal neoplasms, studies without histopathologic diagnoses, non-English language articles, nonhuman animal studies, and abstract-only articles. Two blinded investigators (J.J.L., A.M.P., T.W.E., or N.S.W.) screened each abstract and full text, and a third investigator (J.J.L. or P.P.) adjudicated discrepancies. Of 729 unique citations, 26 studies of 1194 total patients were included.DATA EXTRACTION AND SYNTHESIS Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The Methodological Index for Nonrandomized Studies (MINORS) criteria were used to assess study quality. Two blinded investigators (J.J.L., A.M.P., T.W.E., or N.S.W.) independently extracted data from each study. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was overall survival, and secondary outcomes were disease-free and disease-specific survival. Before data collection, it was hypothesized that the dnSCC cohort would have worse survival outcomes than the IPSCC cohort. RESULTSOne study of patients with dnSCC, 12 studies of patients with IPSCC, and 5 studies with both cohorts were included in the meta-analysis of overall survival. The pooled 5-year overall survival rate for 255 patients with dnSCC was 56% (95% CI, 41%-71%; I 2 = 83.8%) and for 475 patients with IPSCC was 65% (95% CI, 56%-73%; I 2 = 75.7%). Five comparative studies of both cohorts totaling 240 patients with dnSCC and 155 patients with IPSCC were included in another meta-analysis. The pooled overall survival hazard ratio was 1.87 (95% CI, 1.24-2.84; I 2 = 0%).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that patients with dnSCC had almost a 2-fold increased risk of mortality compared with those with IPSCC. Large, multicenter studies are necessary to validate these findings before considering treatment alterations such as de-escalation based on histopathology.

Long‐term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: Systematic review

“…In many instances, malignant transformation does not occur throughout the entire IP tumor bulk itself, and IP‐SCC may only be discovered during definitive resection, with no reliable way to sample for IP‐SCC ahead of time. The overall 5‐year OS rate calculated from individual survival data extracted from 15 studies was 67%, slightly higher than the 62% aggregate mean 5‐year OS values reported by 17 studies, and similar to the 65% reported by a recent study comparing IP‐SCC and de novo SCC (DN‐SCC) survival 44 . The 5‐year OS of 62% likely reflects a more accurate survival percentage given the higher sample size available for data aggregation.…”

“…However, our review suggests IP‐SCC has improved prognosis compared to DN‐SCC. Although reporting on DN‐SCC local and regional recurrence rates are mixed, with some studies finding rates similar to that of IP‐SCC's 23.8% while others finding recurrence rates as high as 56%, primary studies have demonstrated that 5‐year OS for DN‐SCC patients falls between 55.4% and 75% with a recent meta‐analysis placing it at 56%, notably lower than that found of IP‐SCC in the present review 27,29,33,38,44,45 . Whether the contrast in survival and recurrence outcomes can be attributed to differences in tumor biology, tumor stage and grade at presentation, or other factors is yet to be determined.…”

Prognostic Factors and Outcomes of De Novo Sinonasal Squamous Cell Carcinoma: A Systematic Review and Meta‐analysis

“…9,10,59 A recent meta-analysis, for example, reported DN-SCC as a more aggressive tumor portending worse survival outcomes than IP-SCC. 9,60 While this recent meta-analysis, which reported a similar 5-year OS rate (56%) in patients with DN-SCC, focused on survival outcomes between DN-SCC and IP-SCC, it did not assess the impact of treatment and clinical characteristics on survival.…”

EGFR Exon 20 Insertion Mutations in Sinonasal Squamous Cell Carcinoma

“…Overall, the prognosis for SNSCC is poor, averaging ~40% at 5 years [ 65 ]. Although there is no strong data in the literature, patients with de novo SNSCC have almost a twofold increase in mortality compared with those with ISP-associated SNSCC [ 17 , 66 , 67 ], but this does not translate into any meaningful difference in treatment management.…”