Al-Qurayshi Zaid, Smith Ryan, Walsh Jarrett E
Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Ann Otol Rhinol Laryngol. 2020 Nov;129(11):1049-1055. doi: 10.1177/0003489420929048. Epub 2020 May 31.
examine presentation and outcomes of sinonasal squamous cell carcinoma (SCC).
A retrospective study utilizing the National Cancer Database, 2004 to 2015. The study population included adult patients diagnosed with primary sinonasal SCC.
A total of 537 patients were included. The mean age of the study population was 62.6 ± 12.7 years. The median follow-up time was 35.6 months (interquartile range: 8.6-55.9). The histological variants identified are: (i) 66.7% keratinizing SCC, (ii) 21.6% non-keratinizing SCC, (iii) 8.0% papillary SCC, and (iv) 3.7% spindle cell carcinoma. Stage at presentation was: (i) 33.3% T1-2, N0, (ii) 31.8% T3-4a, N0, (iii) 13.8% T1-4a, N+, (iv) 17.0% T4b,N0-3, (v) 4.1% M1. Human papilloma virus (HPV) status was available for 96 patients and tested positive in 24 (25.0%) patients. By histological variants, 5-year survival was lowest for spindle cell carcinoma (40.0%), and highest for papillary SCC (70.1%). HPV negative tumors had a 5-year survival of 26.4%, while HPV positive tumors had a 5-year survival of 57.1% ( = <.001). Of the 255 patients with T1-4a, N0-3, M0 who had surgery of the primary site, 31 (12.2%) patients underwent endoscopic approach. The risk of positive postsurgical margins was not significantly different comparing endoscopic to open approach (23.8% vs 24.1%, >.99).
Sinonasal SCC could present at advanced stages in two-thirds of the population and exhibit a variety of histological subtypes. Like other sites of head and neck, HPV positive tumors are associated with a favorable prognosis. Endoscopic approach is comparable to open approach in terms of post-surgical margins.
研究鼻窦鳞状细胞癌（SCC）的临床表现及预后。
利用国家癌症数据库进行一项回顾性研究，时间跨度为2004年至2015年。研究人群包括诊断为原发性鼻窦SCC的成年患者。
共纳入537例患者。研究人群的平均年龄为62.6±12.7岁。中位随访时间为35.6个月（四分位间距：8.6 - 55.9）。确定的组织学亚型为：（i）66.7%角化型SCC，（ii）21.6%非角化型SCC，（iii）8.0%乳头状SCC，以及（iv）3.7%梭形细胞癌。就诊时的分期为：（i）33.3% T1 - 2，N0，（ii）31.8% T3 - 4a，N0，（iii）13.8% T1 - 4a，N +，（iv）17.0% T4b，N0 - 3，（v）4.1% M1。96例患者可获得人乳头瘤病毒（HPV）状态，其中24例（25.0%）检测呈阳性。按组织学亚型，梭形细胞癌的5年生存率最低（40.0%），乳头状SCC最高（70.1%）。HPV阴性肿瘤的5年生存率为26.4%，而HPV阳性肿瘤为57.1%（P = <.001）。在255例T1 - 4a，N0 - 3，M0且接受原发部位手术的患者中，31例（12.2%）采用了内镜手术入路。内镜手术与开放手术相比，术后切缘阳性风险无显著差异（23.8%对24.1%，P >.99）。
三分之二的鼻窦SCC患者就诊时处于晚期，且表现出多种组织学亚型。与头颈部其他部位一样，HPV阳性肿瘤预后较好。在内镜手术切缘方面，内镜手术入路与开放手术相当。
