Loss of Expression Confers Poor Prognosis to Sinonasal Undifferentiated Carcinoma.

Due to the diverse histopathologic features and variable survival rates seen in sinonasal undifferentiated carcinoma (SNUC), it is likely that this diagnostic entity is comprised of a heterogonous group of morphologically undifferentiated tumors. As advancements in molecular testing have led to a better understanding of tumor biology, it has become increasingly evident that SNUC may actually encompass several tumor subtypes with different clinical behavior. As a result, it is also likely that all SNUC patients cannot be treated in the same fashion. Recent investigations have identified loss of the tumor suppressor (INI1) expression in a subset of undifferentiated sinonasal tumors and extrasinonasal tumors and, studies have suggested that this genetic aberration may be a poor prognostic marker. The objective of this study was to identify differential expression of in SNUC and to analyze and compare the survival outcomes in SNUC patients with and without expression.  All cases of undifferentiated or poorly differentiated neoplasms of the sinonasal tract treated between 2007 and 2018 at a single tertiary care institution were selected. All cases of SNUC were tested for status by immunohistochemistry (IHC). Clinical parameters were analyzed using Student's -test and Fischer's test. Kaplan-Meier methods were used to estimate survival durations, while comparison between both the subgroups was done using the log-rank test. Statistical analysis was performed with the use of SPSS software, Version 25 (IBM, New York, NY, United States).  Fourteen cases of SNUC were identified. Approximately two-thirds (64%;  = 9) of patients were male and the majority (79%;  = 11) were between fifth to seventh decade. Skull base and orbital invasion were seen in 79% (  = 11) and 93% (  = 13) of cases, respectively. Fifty-seven percent of tumors (  = 8) retained expression by IHC (SR-SNUC), while the remaining 43% (  = 6) showed loss of expression and, thus, were considered as -deficient (SD-SNUC). Although clinicopathological features and treatment modalities were similar, SD-SNUC showed poorer (OS:  = 0.07; disease free survival [DFS]:  = 0.02) overall survival (OS) and DFS on Kaplan-Meier curves. Additionally, SD-SNUC showed higher recurrence (75 vs. 17%) and mortality (67 vs. 14%) (hazard rate = 8.562;  = 0.05) rates. Both OS (28.82 ± 31.15 vs. 53.24 ± 37.50) and DFS durations (10.62 ± 10.26 vs. 43.79 ± 40.97) were consistently worse for SD-SNUC. Five-year survival probabilities were lower for SD-SNUC (0.33 vs. 0.85).  SNUC represents a heterogeneous group of undifferentiated sinonasal malignancies. Based on the status of expression, the two subgroups SD-SNUC and SR-SNUC appear to represent distinct clinical entities, with loss of expression conferring an overall worse prognosis.