What are the post–five-year recurrence patterns in sinonasal cancer patients by histologic type?
Bottom Line: Sinonasal cancer shows an 11.7% recurrence rate after a five-year disease-free period, but varies by tumor pathology.
Background: Although rare, sinonasal cancers have a poor prognosis, with overall five-year survival rates ranging from 22% to 67%. A five-year recurrence-free survival outcome in cancer patients is widely accepted to indicate a cure in most cases, but recurrences have been reported even after a five-year disease-free period.
Study design: Retrospective chart review of 241 sinonasal cancer patients diagnosed between January 1990 and December 2011.
Setting: Asan Medical Center, Seoul, South Korea.
Synopsis: The predominant tumor site was the maxillary sinus, followed by nasal cavity, ethmoid sinus, and sphenoid sinus. Cancer types included squamous cell carcinoma, adenoid cystic carcinoma, melanoma, poorly differentiated cancers, olfactory neuroblastomas, sarcoma, and other cancers including mucoepidermoid cancer, adenocarcinoma, and teratocarcinoma. Forty-six patients received surgery only, 99 received surgery and postoperative radiotherapy, and 82 received RT/CRT as the main treatment. A total of 163 patients reached a disease-free state after initial treatment; their pathologic distribution was not different from the total cohort. Of the 163 initial complete remission patients, 83 developed a recurrence and 77 remained disease-free during the five-year follow-up period. Olfactory neuroblastoma patients had the highest survival rate; melanoma cases had the lowest. Nasal soft-tissue cases showed the highest survival rate, followed by ethmoid sinus, maxillary sinus, and sphenoid sinus. Initial tumor stage did not differ much by pathology other than poorly differentiated carcinoma, which accounted for none of the
stage I cases but 54.5% of the stage IV cases. Recurrence rate was highest in melanoma, followed by adenoid cystic carcinoma.
Five-year overall survival was poorest for squamous cell carcinoma; 10-year overall survival was poorest in poorly differentiated carcinoma, followed by melanoma and squamous cell carcinoma. Of 83 recurrence patients, the site was local in 62, regional in 12, and distant in 17. Mean time to recurrence was 40.2 months. The most common post–five-year recurrences were adenoid cystic carcinoma, followed by melanoma, poorly differentiated carcinoma, and squamous cell carcinoma.
Limitations included the rarity of sinonasal cancer, the possibility of selection bias, the study’s retrospective nature, and uncontrollable patient factors.
Citation: Kim SA, Chung YS, Lee BJ, et. al. Recurrence patterns of sinonasal cancers after a 5-year disease-free
period. Laryngoscope. 2019;129:2451–2457.