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Pathogenesis May Impact Survival Outcomes for Sinonasal Squamous Cell Carcinoma

Squamous cell carcinoma.

The prognosis for sinonasal squamous cell carcinoma (SCC) is dismal, with the 5-year overall survival rate estimated to be around 30% to 55%. Sinonasal SCC pathogenesis can result from either de novo or inverted papillomas (IPs)—benign, aggressive neoplasms of the nasal cavity or paranasal sinuses. However, there is little research on whether or not the pathogenesis of sinonasal SCC has an impact on patient outcomes. According to a study recently published in JAMA Otolaryngology-Head & Neck Surgery, patients with de novo SCC (dnSCC) are at an increased risk of mortality compared to those with inverted papilloma-associated SCC (IPSCC).

For this study, led by Jake J. Lee, MD, MSCI, resident in the Department of Otolaryngology-Head and Neck Surgery at Washington University School of Medicine in St. Louis, medical databases including Ovid MEDLINE, Embase, Scopus, and the Cochrane Library were used to gather information on patients with dnSCC and IPSCC. To be included in the review, studies had to have survival outcomes of adults with sinonasal SCC who underwent regular treatment. All clinical trials, cohort studies, case-control studies, and case series were included for review if they had a patient population of 10 adults with sinonasal SCC.

This review included one study of patients with dnSCC, 12 studies of patients with IPSCC, and 5 studies with both patient populations. Compiling all data together, the researchers found that the 5-year overall survival rate for 255 patients with dnSCC was 56%. For 475 patients with IPSCC, it was 65%. Using five studies that compared survival outcomes between 240 patients with dnSCC and 155 patients with IPSCC, a pooled hazard ratio was found to be 1.87 for overall survival, showing that patients with dnSCC have an almost 2-fold increased risk of death compared to patients with IPSCC. The increased risk can be as low as 24% and as high as 200%.

"We hope these results will promote further studies across multiple institutions. Future directions include a prospective cohort study to confirm improved survival outcomes of sinonasal IPSCC or a multicenter collaboration to share individual patient data and retrospectively perform more accurate pooled survival analysis while controlling for confounders like comorbidity and stage," Dr. Lee and colleagues conclude. "Large, multicenter studies are necessary to validate these findings before considering treatment alterations based on histopathology."

For More Information

Lee JJ, Peterson AM, Embry TW, et al (2021). Survival outcomes of de novo vs inverted papilloma-associated sinonasal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. [Epub ahead of print] DOI:10.1001/jamaoto.2020.5261

Image credit: CoRus13. Licensed under CC BY-SA 4.0

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