Rimmer Ryan A, Mace Jess C, Andersen Peter E, Cetas Justin S, Ciporen Jeremy N, Dogan Aclan, Smith Timothy L, Geltzeiler Mathew
Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR.
Division of Head & Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, OR.
Int Forum Allergy Rhinol. 2022 May;12(5):699-713. doi: 10.1002/alr.22909. Epub 2021 Oct 26.
Chondrosarcomas are rare, malignant chondroid tumors that can occur in the sinonasal and skull base regions. Surgery is a mainstay of treatment, but complete resection can be challenging because of the close proximity of critical neurovascular structures. Because of their rarity and relatively indolent nature, optimal treatment regimens are not established. Our objective was to assess determinants of survival for sinonasal and skull base chondrosarcomas utilizing the National Cancer Database (NCDB).
The NCDB (2004-2017) was queried for cases of sinonasal and skull base chondrosarcoma. Multivariate hazard regression modeling was used to identify significant predictors of 60-month and 120-month overall survival (OS).
Seven hundred thirty-six cases met inclusion criteria. OS for all treatment types was 84.7% [SE±0.02] at 60 months and 75.6% [SE±0.02] at 120 months. Surgery with or without adjuvant treatment was found to associate with highest OS at 60 and 120 months. For patients receiving adjuvant radiation during treatment, proton therapy had significantly better OS at 60 months (95.4% [SE±0.03] vs 82.3% [SE±0.03], - = 5.27; p = 0.02) and 120 months (85.1% [SE±0.08] vs 72.8% [SE±0.05], - = 4.11; p = 0.04) compared with conventional external beam. After adjustment for primary site, multivariate Cox regression modeling (n = 561) identified cofactors significantly associated with variation in mortality risk at 60 and 120 months, including age, Charlson-Deyo total score ≥ 3, insurance provision status, and tumor grade.
Sinonasal and skull base chondrosarcoma are primarily treated with surgery with favorable OS. Adjuvant treatment may be required and proton radiation was associated with improved 60-month and 120-month survival compared with conventional radiation.
软骨肉瘤是一种罕见的恶性软骨样肿瘤，可发生于鼻窦和颅底区域。手术是主要的治疗方法，但由于关键神经血管结构位置临近，完整切除具有挑战性。由于其罕见性和相对惰性的特点，尚未确立最佳治疗方案。我们的目的是利用国家癌症数据库（NCDB）评估鼻窦和颅底软骨肉瘤的生存决定因素。
查询NCDB（2004 - 2017年）中鼻窦和颅底软骨肉瘤病例。采用多变量风险回归模型确定60个月和120个月总生存期（OS）的显著预测因素。
736例病例符合纳入标准。所有治疗类型的60个月总生存率为84.7%[标准误±0.02]，120个月为75.6%[标准误±0.02]。发现手术联合或不联合辅助治疗在60个月和120个月时总生存率最高。对于治疗期间接受辅助放疗的患者，质子治疗在60个月时的总生存率显著更高（95.4%[标准误±0.03]对82.3%[标准误±0.03]，- = 5.27；p = 0.02），120个月时（85.1%[标准误±0.08]对72.8%[标准误±0.05]，- = 4.11；p = 0.04），与传统外照射相比。在对原发部位进行调整后，多变量Cox回归模型（n = 561）确定了与60个月和120个月死亡风险变化显著相关的协变量，包括年龄、Charlson - Deyo总分≥3、保险提供状况和肿瘤分级。
鼻窦和颅底软骨肉瘤主要采用手术治疗，总生存率良好。可能需要辅助治疗，与传统放疗相比，质子放疗与60个月和120个月生存率的提高相关。
