Dural Invasion Predicts Neck Metastases in Esthesioneuroblastoma

Background Esthesioneuroblastoma (ENB) exhibits a predilection for neck metastases, and this feature constitutes the most significant predictor of poor long-term survival.^1,2 Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes.^3,4

Objective From this physiologic basis, we hypothesized that patients with dural invasion by ENB would exhibit a proclivity for neck disease.

Methods We retrospectively compared the clinical outcomes of 34 patients with ENB who exhibited dural invasion against the clinical outcomes of 27 patients with ENB but without dural invasion who were treated at our institution between 1994 and 2015.

Results Seventeen of the 34 (50%) patients with dural invasion presented with or developed neck disease. Conversely, 6 of the 27 (22%) patients without dural invasion exhibited neck disease, and this difference in incidence was statistically significant (p = 0.026). Regional recurrence-free survival also significantly differed between patients with and without dural invasion (p = 0.022). At 5 years, the regional recurrence-free survival rates were 64 and 88%, respectively (Fig. 1A). Evaluation by the modified Kadish stage indicated that Kadish C patients with dural invasion were more likely to develop regional recurrence when compared with Kadish C without dural invasion and Kadish A/B (p = 0.083; Fig. 2A). Further, Kadish C patients with dural invasion displayed worse overall survival than Kadish C without dural invasion and Kadish A/B. Kadish D patients displayed the worst overall survival. The difference in overall survival among these four groups was statistically significant (p < 0.001; Fig. 2C).

Conclusion Dural invasion by ENB is associated with increased incidence of cervical nodal metastases, regional recurrence-free survival, and poorer overall survival.

Fig. 1 Survival rates by dural invasion status from the date of diagnosis displaying (A) regional recurrence-free survival and (B) overall survival.

Fig. 2 Survival rates by modified Kadish stage and dural invasion status from the date of diagnosis displaying (A) regional recurrence-free survival, (B) any recurrence-free survival, and (C) overall survival.