Prognostic Factors in Sinonasal Cancers: A Multicenter Pooled Analysis

ABSTRACT Objectives Sinonasal cancers (SNC) are heterogeneous diseases with different clinical behavior. We aimed to identify prognostic factors in non‐metastatic (M0)‐SNC. Methods Electronic health records from M0‐SNC patients treated with definitive surgery ± postoperative radiotherapy or chemoradiotherapy at two tertiary institutions were reviewed. p16 staining was performed in the squamous cell carcinoma (SCC) subset. Multivariable analysis (MVA) calculated the adjusted hazard ratio (aHR) for histology type (SCC as the comparator), T/N categories, and primary treatment modality for the risk of locoregional failure (LRF), distant metastasis (DM), and deaths. Results A total of 376 patients were eligible including 209 (56%) SCC (p16+: 35; p16−/untested: 157), 42 (11%) adenocarcinoma, 35 (9%) sinonasal undifferentiated carcinoma or sinonasal neuroendocrine tumors (SNUC/SNEC), 33 (9%) mucosal melanoma (MM), 30 (8%) esthesioneuroblastoma (ES), and 27 (7%) adenoid cystic carcinoma (ACC). MVA identified MM histology (aHR 2.03, 95% CI 21.23–3.33), older age (aHR 1.02; 95% CI: 1.00–1.03), T3–4 tumor (aHR 5.08, 95% CI 2.77–9.30), and nodal involvement (aHR: 2.15, 95% CI 1.46–3.16) carried higher mortality risk (all p < 0.05); MM (aHR 10.14, 95% CI 4.90–21.01), ACC (aHR 2.97, 95% CI 1.27–6.96), and SNUC/SNEC (aHR 6.80, 95% CI 3.30–14.01) histologies and T3–4 categories (vs. T1–2, HR 4.79, 95% CI 1.53–14.95) had higher DM risk; T3–4 (aHR 2.33, 95% CI 1.37–3.97) and nodal involvement (aHR 1.70, 95% CI 1.11–2.60) conveyed higher LRF risk while SNUC/SNEC histologies had a lower LRF risk (aHR 0.51, 95% CI 0.26–3.33). Conclusions Different SNC histology types exhibit distinct patterns of relapse and survival, highlighting the need for different management strategies. Level of Evidence 4.