Outcomes in Sinonasal Adenocarcinoma: A Single Institution Experience

Presentation: A082
Topic: Nasopharynx / Paranasal Sinus / Skull Base
Type: Poster
Date:
Session:
Authors: Elliot Morse, MD, MHS; Dauren Adilbay; Cristina Valero, MD; Ximena Mimica, MD; Piyush Gupta, MD; Jennifer Cracchiolo, MD; Snehal Patel, MD; Jatin Shah, MD; Ian Ganly*, MD, PhD; Marc Cohen*, MD, MHS
Institution(s): Memorial Sloan Kettering Cancer Center


Introduction:

Sinonasal malignancies are rare, accounting for just 3% of head and neck cancers. Despite being the second most common sinonasal pathology, adenocarcinoma is seen in only 13% of these malignancies. Due to its rarity treatment approaches, prognostic factors, and outcomes are not well-defined. In this study, we aim to review the outcomes of sinonasal adenocarcinoma at a tertiary North American center.

Methods: Following institutional review board approval, patients were identified from an existing institutional  tumor database from 1973 – 2018. Demographic, tumor, treatment, and survival variables were summarized in the overall cohort. Survival curves were calculated via the Kaplan-Meier method, and patient, tumor, and treatment characteristics were assessed for association with survival via Cox proportional hazards regression. Factors with p<0.2 in the univariable regression were included in the multivariable analysis.

Results: 52 patients met inclusion criteria. Median age was 57 years (interquartile range [IQR]: 49-66). Males represented 30 (58%) of the cohort. Tumor sites were nasal cavity (23 [44%]), ethmoid sinus (14 [27%]), maxillary sinus (10 [19%] and other (5 [10%]). The majority were primary tumors (46 [88%]). Tumor stages were T3/T4 in 36 (59%). Nodal metastases were seen in 4 patients (8%). Orbital invasion was observed in 6 (12%) patients. Skull base resection was performed in 15 patients (29%). Negative margins were achieved in 32 patients (62%), positive margins in 12 (23%), and unknown margin status in 8 (15%). Adjuvant radiation with or without chemotherapy was used in 28 patients (54%). Five year overall survival (OS) and disease specific survival was 73% and 78%, respectively. Five-year OS was 93% for T1/T2 tumors and 65% for T3/T4 tumors. Five year DSS was 100% for T1/T2 tumors and 69% for T3/T4 tumors. Five year local recurrence free probability was 56%. On multivariable analysis, positive margins and orbital invasion predicted poorer OS (hazard ratio [HR] 2.9 [95% confidence interval (CI): 1.1-7.5] and HR 6.8 [95% CI: 1.6-29.3], respectively). There was no significant association of age (HR: 1.01 [95% CI: 0.98-1.04]), T stage (T3/4 versus T1/2 HR: 1.88 [95% CI: 0.91-5.00]), N stage (N+ vs N0/Nx HR: 1.70 [95% CI: 0.51-5.72]), skull base resection (yes vs no HR: 0.77 [95% CI: 0.28-2.10]), or adjuvant treatment (HR 0.96 [95% CI: 0.44-2.08]).

Conclusion: Here we summarize our institution’s experience with sinonasal adenocarcinoma. We described patient, tumor, and treatment patterns. Overall survival was strongly associated with margin status and orbital invasion.