Lehrich Brandon M, Goshtasbi Khodayar, Abiri Arash, Yasaka Tyler, Sahyouni Ronald, Papagiannopoulos Peter, Tajudeen Bobby A, Kuan Edward C
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA.
Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
Int Forum Allergy Rhinol. 2020 May;10(5):679-688. doi: 10.1002/alr.22536. Epub 2020 Feb 27.
Sinonasal undifferentiated carcinoma (SNUC) is an uncommon malignancy of the nasal cavity and accessory sinuses with limited available studies evaluating role of induction chemotherapy (IC), demographics, and socioeconomic factors on overall survival (OS).
The 2004-2015 National Cancer Database was queried for patients with histologically confirmed SNUC. IC was defined as chemotherapy administered 6 months to 2 weeks before surgery or ≥45 days before radiotherapy.
Of 440 identified patients, 70 (16%) underwent treatments involving IC. This consisted of 52 (12%), 15 (3%), and 3 (1%) patients receiving IC before definitive radiation therapy, surgery and adjuvant radiotherapy, or surgery only, respectively. On univariate analysis, IC (p = 0.34) did not affect OS, whereas having government insurance (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.37-2.34; p < 0.001) and living in regions with ≥13% of the population without a high school diploma (HR, 1.38; 95% CI, 1.06-1.79; p = 0.02) were associated with worse OS. On log-rank test, patients with advanced stage had similar OS regardless of whether or not they received IC (p = 0.96). Patients who received IC lived closer to their treatment site (p = 0.02) and had worse overall health, with more comorbidities (p = 0.02). The timing of IC before definitive surgery or radiation did not affect OS (p = 0.69).
In this SNUC population-based analysis, IC did not appear to provide additional OS benefit regardless of disease stage or timing before definitive treatment. Distance to treatment and level of comorbidities may be associated with receiving IC, whereas type of insurance and residence education level may impact SNUC OS, regardless of treatment.
鼻窦未分化癌（SNUC）是鼻腔和鼻窦的一种罕见恶性肿瘤，关于诱导化疗（IC）的作用、人口统计学和社会经济因素对总生存期（OS）影响的现有研究有限。
查询2004 - 2015年国家癌症数据库中组织学确诊为SNUC的患者。IC定义为在手术前6个月至2周或放疗前≥45天给予的化疗。
在440例确诊患者中，70例（16%）接受了涉及IC的治疗。其中分别有52例（12%）、15例（3%）和3例（1%）患者在确定性放疗、手术及辅助放疗或仅手术前接受了IC。单因素分析显示，IC（p = 0.34）不影响OS，而拥有政府保险（风险比[HR]，1.79；95%置信区间[CI]，1.37 - 2.34；p < 0.001）以及居住在高中文凭以下人口比例≥13%的地区（HR，1.38；95% CI，1.06 - 1.79；p = 0.02）与较差的OS相关。对数秩检验显示，晚期患者无论是否接受IC，OS相似（p = 0.96）。接受IC的患者居住距离治疗地点更近（p = 0.02）且总体健康状况较差，合并症更多（p = 0.02）。在确定性手术或放疗前IC的时间不影响OS（p = 0.69）。
在这项基于人群的SNUC分析中，无论疾病分期或在确定性治疗前的时间如何，IC似乎都不能提供额外的OS获益。距离治疗地点和合并症水平可能与接受IC有关，而保险类型和居住教育水平可能影响SNUC的OS，与治疗无关。
