Patel Neil N, Maina Ivy W, Kuan Edward C, Triantafillou Vasiliki, Trope Michal A, Carey Ryan M, Workman Alan D, Tong Charles C, Kohanski Michael A, Palmer James N, Adappa Nithin D, Newman Jason G, Brant Jason A
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2020 Dec;81(6):701-708. doi: 10.1055/s-0039-1696707. Epub 2019 Sep 12.
Sinonasal adenocarcinoma (SNAC) is a rare malignancy arising from mucus-secreting glandular tissue. Limited large-scale studies are available due to its rarity. We evaluated SNAC in the National Cancer Database (NCDB), a source that affords multi-institutional, population studies of rare cancers and their outcomes. The NCDB was queried for adenocarcinoma in the sinonasal tract. Multivariate analyses were performed to evaluate for factors contributing to overall survival (OS). A total of 553 patients were identified. The cohort was composed of 59.3% males. The nasal cavity was the most common primary site, representing 44.1% of cases. About 5.7% of patients presented with nodal disease, while 3.3% had distant metastases. About 40.6% of cases presented with stage IV disease. About 73.5% of patients underwent surgery, 54.2% received radiation therapy, and 27.7% had chemotherapy. Median OS was 71.7 months, while OS at 1, 2, and 5 years was 82, 73.0, and 52%, respectively. On multivariate analysis, advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02-1.05), Charlson-Deyo score of 1 (HR: 1.99; 95% CI: 1.20-3.30), advanced tumor grade (HR: 2.73; 95% CI: 1.39-5.34), and advanced tumor stage (HR: 2.71; 95% CI: 1.33-5.50) were associated with worse OS, whereas surgery (HR: 0.34; 95% CI: 0.20-0.60) and radiation therapy (HR: 0.55; 95% CI: 0.33-0.91), but not chemotherapy (HR: 1.16; 95% CI: 0.66-2.05), predicted improved OS. SNAC is a rare malignancy with 5-year survival approximating 50%. Surgery and radiation therapy, but not chemotherapy, are associated with improved survival, and likely play a critical role in the interdisciplinary management of SNAC.
鼻窦腺癌（SNAC）是一种起源于黏液分泌腺组织的罕见恶性肿瘤。由于其罕见性，大规模研究有限。我们在国家癌症数据库（NCDB）中评估了SNAC，该数据库可用于对罕见癌症及其预后进行多机构、基于人群的研究。
在NCDB中查询鼻窦腺癌病例。进行多变量分析以评估影响总生存期（OS）的因素。
共识别出553例患者。该队列中男性占59.3%。鼻腔是最常见的原发部位，占病例的44.1%。约5.7%的患者出现淋巴结疾病，3.3%有远处转移。约40.6%的病例为IV期疾病。约73.5%的患者接受了手术，54.2%接受了放射治疗，27.7%接受了化疗。中位总生存期为71.7个月，1年、2年和5年的总生存率分别为82%、73.0%和52%。多变量分析显示，高龄（风险比[HR]：1.04；95%置信区间[CI]：1.02 - 1.05）、Charlson - Deyo评分为1（HR：1.99；95% CI：1.20 - 3.30）、肿瘤分级高（HR：2.73；95% CI：1.39 - 5.34）和肿瘤分期晚（HR：2.71；95% CI：1.33 - 5.50）与较差的总生存期相关，而手术（HR：0.34；95% CI：0.20 - 0.60）和放射治疗（HR：0.55；95% CI：0.33 - 0.91），但不是化疗（HR：1.16；95% CI：0.66 - 2.05），预示着总生存期改善。
SNAC是一种罕见的恶性肿瘤，5年生存率约为50%。手术和放射治疗而非化疗与生存率提高相关，并且可能在SNAC的多学科管理中起关键作用。
