Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?

Background: Sinonasal squamous cell carcinoma (SCC) is a rare tumor. Treatment involves multiple modalities, as well as a multidisciplinary team of specialists. Due to the complexity and infrequency of sinonasal SCC, clinical volume, and experience of the treating center may contribute to patient outcomes.

Methods: The National Cancer Database (NCDB) dataset from 2004 to 2014 was analyzed. Patients with sinonasal SCC were identified. Patient demographics, tumor characteristics including primary site, tumor classification (T-stage), resection margins, treatment regimen (surgery, radiation, chemotherapy, and multimodality), and facility case-specific volume averaged per year and grouped in tertiles as low (0–33%), medium (33–67%), and high (67–100%) were compared. Overall survival was compared using Cox’s proportional hazards regression analysis.

Results: A total of 3,835 patients who were treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options for patients included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. On multivariate analysis, patients who underwent surgery with adjuvant RT had better overall survival (HR = 0.74, p ≤0.001, CI: 0.63–0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. For all patients who underwent treatment, univariable analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR = 0.77, p = 0.002). Multivariable Cox-PH regression analysis adjusting for age, sex, tumor classification, and treatment regimen demonstrated that patients who underwent treatment at a high-volume facility (HR = 0.81, p < 0.001) had statistically significantly improved survival.

Conclusion: This study shows a better overall survival for sinonasal SCC treated at high volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.

No conflict of interest has been declared by the author(s).